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					June 2011

Dear Parents:

We thank the parents of Summit School students for   helping to make this
another successful year for all of us. We know you   feel as proud as we
are of your child's achievements. For new parents,   we will do our best
to help your child have a very positive experience   at Summit.

Enclosed please find:

    2011/2012 School Calendar: Please reserve these dates:
       1) Back to School Night: Upper School October 5,
              Lower School October 6.
       2) Parent/TeacherConferences: Lower School November 10,
              Upper School November 16.
       3) Benefit at The Pierre Hotel: November 21, 2011

    Required forms that must be completed by July 25: Please follow
    the instructions on each form. Our school office processes these
    required forms during the month of June, so please return the
    forms early.

The following school supplies will be distributed to each student on the
first day of school:
       1) Loose-leaf binder               5) Pens & pencils
       2) Loose-leaf paper                6) Homework folder
       3) Dividers                        7) Schedule folder
       4) Pencil case                     8) Calculator (not graphing)

Our school office is open during the month of August from 9:00 a.m. to
2:00 p.m., Monday through Thursday. If you have any questions or
concerns, please contact the main office at (718)264-2931.

We anticipate another outstanding school year filled with experiences
that will optimize your child's potential. We hope you and your family
have a wonderful summer.

Sincerely,


JOHN RENNER
Director


RICHARD SITMAN
Director
ens.
 187-30 Grand Central Parkway                                                                                                                   183-02 Union Turnpike
 Jamaica Estates, NY 11432                                                                                                                      Flushing, NY 11366
 718/264-2931                                                             The Summit School Calendar 2011/2012                                  718/969-3944



                                                    September
                 September 2011                     9/1-9/2 Staff Orientation                                      February 2012                     February
Su      M      T      W      Th           F    Sa   9/5 Labor Day                                  Su    M       T     W       Th     F    Sa        2/20-2/24 Mid Winter Recess
                             1            2    3    9/6 First Day of School                                            1       2      3    4
4       5      6      7      8            9    10   9/14 New Parents Meet. 6:30pm                  5     6       7     8       9      10   11
11      12     13     14     15           16   17   9/19 Session of Mon. R.E.A.P.                  12    13      14    15      16     17   18
18      19     20     21     22           23   24   9/20 Session of Tues. R.E.A.P.                 19    20      21    22      23     24   25
25      26     27     28     29           30        9/22 Session of Thu. R.E.A.P.                  26    27      28    29
                                                    9/29 – 9/30 Rosh Hashanah



                     October 2011                                                                                     March 2012                     March
Su      M      T         W      Th        F    Sa   October                                        Su    M       T       W      Th    F    Sa        3/21 US Parent/Teacher Conf.
                                               1    10/10 Columbus Day                                                          1     2    3         3/29 LS Parent /Teacher Conf.
2       3      4        5      6          7    8    10/5 US Back to School Night – 7:00 pm         4     5       6       7      8     9    10
9       10     11       12     13         14   15   10/6 LS Back to School Night – 7:00 pm         11    12      13      14     15    16   17
16      17     18       19     20         21   22   10/13 LS Trip                                  18    29      20      21     22    23   24
                                                    10/14 Sukkot
23      24     25       26     27         28   29                                                  25    26      27      28     29    30   31
                                                    10/20 US Trip
30      31
                                                    10/21 Sukkot



                 November 2011                      November                                                          April 2012
Su      M      T     W      Th            F    Sa   11/2 ½ day Staff Conferences                   Su    M       T      W        Th   F    Sa        April
               1     2      3             4    5                                                   1     2       3      4        5    6    7         4/5-4/13 Spring Recess
                                                    11/10 LS Parent/Teacher Conferences
6       7      8     9      10            11   12   11/11 Veterans Day                             8     9       10     11       12   13   14
13      14     15    16     17            18   19   11/16 US Parent/Teacher Conferences            15    16      17     18       19   20   21
20      21     22    23     24            25   26   11/21 LS Thanksgiving Luncheon                 22    23      24     25       26   27   28
27      28     29    30                             11/21 Benefit – Pierre Hotel – 6pm             29    30
                                                    11/22 US Thanksgiving Luncheon
                                                    11/23-11/28- Thanksgiving recess

                 December 2011                                                                                        May 2012
Su      M      T     W      Th            F    Sa   December                                       Su    M       T     W         Th   F    Sa        May
                            1             2    3    12/7 ½ day Staff Conferences                                 1     2         3    4    5         5/17 REAP ends
                                                    12/23-1/2 Winter Recess                                                                          5/25 –5/29 Memorial Day Recess
4       5      6     7      8             9    10                                                  6     7       8     9         10   11   12
11      12     13    14     15            16   17                                                  13    14      15    16        17   18   19
18      19     20    21     22            23   24                                                  20    21      22    23        24   25   26
25      26     27    28     29            30   31                                                  27    28      29    30        31


                                                    January
                  January 2012                      1/1 – 1/2 Winter Recess                                           June 2012
Su      M      T      W      Th           F    Sa   1/11 Staff Conference Day                      Su    M       T      W       Th    F    Sa
                                                    1/12 REAP ends                                                                                   June
1       2      3      4      5            6    7                                                                                      1    2
                                                    1/16 Martin Luther King                                                                          6/6 US Picnic
8       9      10     11     12           13   14                                                  3     4       5      6        7    8    9         6/7 LS Picnic
15      16     17     18     19           20   21   1/23 2nd Session of Mon. R.E.A.P.              10    11      12     13       14   15   16
                                                    1/24 2nd Session of Tues. R.E.A.P.                                                               6/8 US Career Assembly
22      23     24     25     26           27   28                                                  17    18      19     20       21   22   23        6/13 Moving Up Breakfast
                                                    1/26 2nd Session of Thu. R.E.A.P.
29      30     31                                                                                  24    25      26     27       28   29   30        6/22 HS Graduation
                                                                                                                                                     6/26 Last Day of School
                                                                                                                                                          Staff & Students

     School Closed           Staff Only
                                                                                     Return	
  all	
  forms	
  to:	
  
                                                                                                  	
  
                                                                                187-­‐30	
  Grand	
  Central	
  Parkway	
  
                                                                                  Jamaica	
  Estates,	
  NY	
  11432	
  
                                                                                            718-­‐264-­‐2931	
  
                                                                            http://www.summitschoolqueens.com	
  

	
                                                     	
  
                                                  Required	
  Forms	
  
                                                                          	
  
Please	
  complete	
  the	
  enclosed	
  forms	
  and	
  return	
  them	
  to	
  the	
  Upper	
  School.	
  Our	
  school	
  
office	
  processes	
  these	
  required	
  forms	
  during	
  the	
  month	
  of	
  June,	
  so	
  please	
  return	
  the	
  
forms	
  early!	
  	
  
	
  
❏	
  1.	
  Parent	
  Contact	
  and	
  Emergency	
  Information	
  Form	
  (for	
  new	
  students).	
  
	
  
❏	
  2.	
  Final	
  Records	
  Request	
  (for	
  new	
  students).	
  
	
  
❏	
  3.	
  Health	
  Appraisal	
  Form	
  
	
           •	
  Required	
  for	
  new	
  admissions	
  and	
  before	
  entering	
  grades	
  2,	
  4,	
  7,	
  and	
  10.	
  
	
           •	
  Required	
  for	
  students	
  who	
  participate	
  in	
  team	
  sports.	
  
	
           •	
  Must	
  be	
  signed	
  by	
  a	
  physician.	
  
	
  
❏	
  4.	
  Medication	
  Form	
  (Prescription	
  and	
  non-­‐prescription)	
  
	
           •	
  Must	
  be	
  completed	
  each	
  school	
  year	
  for	
  all	
  students.	
  
	
           •	
  Medication	
  must	
  be	
  sent	
  to	
  school	
  in	
  the	
  original	
  pharmacy	
  bottle.	
  
	
           •	
  A	
  copy	
  of	
  the	
  prescription	
  must	
  be	
  on	
  file.	
  
	
  
❏	
  5.	
  Dental	
  Health	
  Certificate	
  
             •	
  Required	
  for	
  new	
  admissions	
  and	
  before	
  entering	
  grades	
  2,	
  4,	
  7,	
  and	
  10.	
  
	
  
❏	
  6.	
  Release	
  Form	
  and	
  Digital	
  Media	
  Consent	
  Form.	
  
	
  
❏	
  7.	
  Lunch	
  Permission	
  Form	
  
	
           •	
  Students	
  ages	
  12	
  and	
  above.	
  (Parent	
  and	
  staff	
  permission	
  required).	
  
	
  
❏	
  8.	
  Swim	
  Questionnaire	
  (For	
  Lower	
  School)	
  
	
           •	
  Must	
  be	
  completed	
  by	
  new	
  admissions	
  only.	
  
	
  
❏	
  9.	
  P.A.	
  Membership	
  and	
  Questionnaire	
  
	
           •	
  Register	
  and	
  pay	
  your	
  dues	
  online.	
  
	
  
❏	
  10.	
  Recreational	
  Enrichment	
  After-­‐School	
  Program	
  Brochure	
  and	
  Registration	
  Form.	
  
	
  
	
  
                                These	
  forms	
  are	
  also	
  available	
  online.	
  Please	
  visit:	
  
                          http://www.summitschoolqueens.com/parentinfo.html	
  
                                                                187-30 Grand Central Parkway
                                                              Jamaica Estates, New York 11432
                                                                       718-264-2931
                                                            http://www.summitschoolqueens.com




June, 2011


Dear Parent,

We are looking forward to having your child join us in September, 2011. In order to accurately
plan his/her program, we need a copy of the final report card along with the results of any
Regents examinations. Please fax or mail this information to:

Nancy Morgenroth
Director of Admissions
The Summit School
187-30 Grand Central Parkway
Jamaica Estates, N.Y. 11432
Fax# (718) 264-1737.

Thank you in advance for your cooperation.



Nancy Morgenroth, N.S. CCC-SLP
Director of Admissions



Tina Rosenbaum, Ed.D
Director of Educational Servicees
                                                   The Summit School Health Appraisal Form
   NYSED requires an annual physical exam for new admissions, students in grades 2, 4, 7, and 10, sports teams, and triennially for the Committee
   for Special Education. This exam complies with the NYSED requirements with the exception of any illness or injury lasting more than five days
   that will require review by private health care provider and School Nurse .

Name:                                                                      Gender:       M         F   Date Of Birth.:                   School Year:___________

Immunizations/ Health History
       Immunization record attached                          Sickle Cell Screen        Positive         Negative Date: ____________             Not Done
                                                              PPD                      Positive         Negative Date: ____________             Not Done
       No Immunizations given today
                                                              Elevated Lead            Yes              No       Date: ____________             Not Done
       Immunization given since last appraisal                Dental Referral          Yes               No        Date: ____________           Not Done

  Significant Medical/ Surgical History:                    See Attached _____________________________________________________________

  __________________________________________________________________________________________________________________

   Specify current diseases:                     Asthma          Diabetes              Hypertension           Ear Infections
                                                 Seizures        Hyperlipidemia        Heart Trouble          Other

   Allergies:        LIFE THREATENING              Seasonal             Food: _______________________                 Medication: __________________
                     No Allergies                                       Insect: ______________________                Other: ______________________

Physical Exam
   Height: ____________            Weight: ____________                Blood Pressure: ____________                   Date of Exam: ____________


                                                                                                                               R          L             Referral
  Body Mass Index: ___________ _________._______                            Vision- without glasses/contact lenses
                                                                            Vision- with glasses/contact lenses                R          L
  Weight Status Category (BMI percentile):                                  Vision- Near Point
                                                                                                                               R          L
      less than 5th            85th through 94th                            Hearing          Pass 20db sc both ears or:
      5th through 49th         95th through 98th                                                                               R          L
      50th through 84th        99th and higher                              Glasses          Yes        No

     EXAM ENTIRELY NORMAL                                  Scoliosis: Negative    Positive:_________________________________
  Other Medical Alert: ____________________________________________________________________________________________________

  Specify any abnormality (Use reverse of form if needed):

  ____________________________________________________________________________________________________________________
  Known history of seizures: ______________________________________________________________________________________________________________________________________

Medications
Medications (list all) None      Additional medications listed on reverse of form (Medication orders are vailid for the current school year.)
Name: ______________________________________________________________ Dosage/Time: ______________________________________

Name:________________________________________________________ _______Dosage/Time: ______________________________________

Name:________________________________________________________ _______Dosage/Time:_______________________________________

Instructions if AM dose is missed at home :____________________________________________________________________________________
Note: School Nurse will assess self-direction for the school setting. Please advise parent to send in an additional 3 day supply of medication in the
event that emergency sheltering is necessary at school or if the morning medication has not been given.

Physical Education / Sports / Playground / Work Qualification / CSE
   Free from contagions & physically qualified for all physical education, sports, playground, work and school activities            OR only as checked:
___Limited contacts: cheerlead, gymnastics, volleyball, handball, baseball, floor hockey, softball
___Non-contact: bowl, golf, swim, table tennis, weight train, dance, running, walking
   Specify medical accommodations needed for school: __________________________________________________________                                      None
   Known or suspected disability: ____________________________________________________________________________                                       Please Monitor
                                                                                                                   Please Monitor
   Restrictions: __________________________________________________________________________________________
   Protective equipment required: Athletic Cup  Sport goggles/impact resistant eyewear Other _________________________________


Provider's Signature: __________________________________________________________ Date: ____ __________ Phone: ___________________

Provider's Name & Address: ______________________________________________________________ _________ Fax: _____________________

Parent's Signature: _______________________________________________________________________________ Date: ____________________
                                                  The Summit School Health Appraisal Form
Name:

 New York State Law Requires a Certificate of Immunization Before Admittance to School
         DPT/DTaP       OPV/IPV          MMR        Mumps             HIB         HEPB           HEPA           HPV         Varicella     Pneumococcal


                                                                                                                                          Meningococcal
                                     Measles         Rubella
  DT
  Td
 Tdap
                                                     Influenza     Other Vaccine       Other           Other            Other
        Mantoux Test Chest XRay Lead Screen           Vaccine


          Result         Result         Result                         Result          Result          Result          Result



  I certify that the aforementioned student has completed all required immunizations.

  Doctor's Signature: __________________________________________________ Date: _________________________

  I certify that the aforementioned student will have completed all required immunizations by :_______________________

  Doctor's Signature: __________________________________________________ Date: _________________________

 ADDITIONAL INFORMATION
 Additional findings on physical exam:              Date: __________________ Findings: __________________________________________________

  _______________________________________________________________________________________________________________________________

 ________________________________________________________________________________________________________________________________

 Additional Medications:                                                                    (Medication orders are valid for the current school year )



 Name: ______________________________________________________________ Dosage/Time: ______________________________

 Name:________________________________________________________________Dosage/Time: ______________________________


 Additional Recommendations/Referrals: __________________________________________________________________________
  _________________________________________________________________________________________________________________

 Provider's Signature: ________________________________________________________ Date: ______________ Phone: ___________________


 Provider's Name/Address: ________________________________________________________________________ Fax: _____________________

 Parent Signature: _______________________________________________________________________________ Date: ____________________

  Permission to Treat

 Student's Name: ______________________________________________________________


 I, (Parent/Guardian's name) ____________________________________________ hereby give my consent to have my child receive First-Aid treatment by
 the School Nurse. In case of extreme emergency, my child may be transported to a nearby hospital for further evaluation and treatment. Every effort will be
 made to reach an adult listed on the Emergency Contact Card.

 Signature: ________________________________________________________________ Date: _________________________________

 Relationship to child: _______________________________________________________________________________________________
                         MEDICATION FORM – 2011/2012 SCHOOL YEAR
 This form is to be used for both prescription and non-presciption medications and is required for all students.
 Your child can be given non-prescription medication in school (e.g., Tylenol) at the discretion of Summit staff only if this
 form is filled out. New York State law requires a physician’s signature and attached prescription for prescribed
 medications that are adminstered at school.

 Name of Child: ______________________________________                                Date of Birth: _________________

 (1).Medication Administered at Home:
 Name of Medication: _____________________________________________________________________
 Dosage: _______________________________________________________________________________
 Date Medication was initiated: ______________________________________________________________



  (2).Instructions for Medication Administered During School Hours:
  Name of medication: _____________________________________________________________________
  Dosage: _______________________________________________________________________________
  Time of administration: ___________________________________________________________________
  Side effects to watch for in the classroom: ____________________________________________________


  (3). Instructions for Use of Medication for Severe Allergic Reactions or Inhaler Administered During School
      Hours:
  Name of medication: ____________________________________________________________________
  Dosage: ______________________________________________________________________________
  Conditions for administration: _____________________________________________________________
  Please check:                     ____ Administered by Staff              ____ Administered by Student
  Side effects to watch for in the classroom: ___________________________________________________

  (4). Non-Prescription Medication Which May Be Administered in School:
  Please circle : Aspirin   Advil      Benedryl   Immodium       Pepto-Bismol       Tums   Tylenol

  Other: _______________________________________________________________________________
  Conditions for administration: _____________________________________________________________

Name of Physician (please print): __________________________________________________________________


Signature of Physician (For Rx only)              Telephone #               Fax #                    Date
Name of Psychiatrist, Psychologist, &/or Psychopharmacologist:______________________________________________
____________________                      _________________
Telephone#                                Fax#
I hereby authorize The Summit School personnel to administer this medication to my child.


Signature of Parent                               Telephone #              Fax #                     Date
                                                            Dental Health Certificate
Parent/Guardian: New York State law (Chapter 281) permits schools to request a dental examination in the following grades: school entry,
K, 2, 4, 7, & 10. Your child may have a dental check-up during this school year to assess his/her fitness to attend school. Please complete
Section 1 and take the form to your dentist for an assessment. If your child had a dental check-up before he/she started the school, ask
your dentist to fill out Section 2. Return the completed form to the school's medical director or school nurse as soon as possible.

                                        Section 1. To be completed by Parent or Guardian (Please Print)
                                 Last                           First                                                    Middle

Child's Name:

Birth Date:             /    /               Sex:   __   Male           Will this be your child's first visit to a dentist?   __Yes ____ No
                    Month Day Year                  _ Female

School:   The Summit School                                                                                                               Grade


Have you noticed any problem in the mouth that interferes with your child's ability to chew, speak or focus on school activities? _Yes _No

I understand that by signing this form I am consenting for the child named above to receive a basic oral health assessment. I understand
this assessment is only a limited means of evaluation to assess the student's dental health, and I would need to secure the services of a
dentist in order for my child to receive a complete dental examination with x-rays if necessary to maintain good oral health. I also
understand that receiving this preliminary oral health assessment does not establish any new, ongoing or continuing doctor-patient
relationship. Further, I will not hold the dentist or those performing this assessment responsible for the consequences or results should I
choose NOT to follow the recommendations listed below.

Parent's Signature ______________________________________________________Date: __________________________

                                                    Section 2. To be completed b the Dentist

I. The Dental Health condition of _____________________________ on _______________________(date of exam) The date of the
exam needs to be within 12 months of the start of the school year in which it is requested. Check one:

      ____ Yes, The student listed above is in fit condition of dental health to permit his/her attendance at the public schools.

      ____ No, The student listed above is not in fit condition of dental health to permit his/her attendance at the public schools.

NOTE: Not in fit condition of dental health means that a condition exists that interferes with a student's ability to chew, speak or focus on
school activities including pain, swelling or infection related to clinical evidence of open cavities. The designation of not in fit condition of
dental health to permit attendance at the public school does not preclude the student from attending school.

Dentist's name and address (please print or stamp) Dentist's Signature




Optional Sections - If you agree to release this information to your child's school, please initial her:._______________

11. Oral Health Status (check all that apply),
__   Yes __No       Caries Experience/Restoration History - Has the child ever had a cavity (treated or untreated)? [A filling
                    (temporary/permanent) OR a tooth that is missing because it was extracted as a result of caries OR an open cavity].

__ Yes    __   No   Untreated Caries - Does this child have an open cavity? [At least 1/2 mm of tooth structure loss at the enamel surface.
                    Brown to dark brown coloration of the walls of the lesion. These criteria apply to pits and fissure cavitated lesions as well
                    as those on smooth tooth surfaces. If retained root, assume that the whole tooth was destroyed by caries. Broken or
                    chipped teeth, plus teeth with temporary fillings, are considered sound unless a cavitated lesion is also present].

__   Yes __No       Dental Sealants Present

Other problems (Specify): ___________________________________________________________________________________

III. Treatment Needs (check all that apply)
          __ No obvious problem. Routine dental care is recommended. Visit your dentist regularly.
          __ May need dental care. Please schedule an appointment with your dentist as soon as possible for an evaluation.
          __ Immediate dental care is required. Please schedule an appointment immediately with your dentist to avoid problems.
                                                 187-30 Grand Central Parkway
                                               Jamaica Estates, New York 11432
                                                        718-264-2931
                                             http://www.summitschoolqueens.com


              PLEASE COMPLETE BOTH SIDES OF THIS FORM

                              RELEASE FORM
                         2011/2012 SCHOOL YEAR
Student’s Name:_______________________    Date of Birth: _______________


I authorize THE SUMMIT SCHOOL to do the following:

 1. To have my child taken off the school’s premises for field trips with
     staff supervision. This includes students 14 years and above who
     participate in our work program.

 2. To render or obtain first aid or medical treatment for my child in
     case of emergency in the event that I cannot be contacted
     immediately.

 3. To administer medication as prescribed by my child’s physician.

 4. To release information concerning my child to other agencies after I
     (parent or legal guardian) provide written consent to release the
     information requested on a case by case basis in compliance with
     FERPA Regulations.

 5. To obtain information concerning my child from other agencies.

 6. To have my child engage in physical education activities conducted
     and supervised by the school.

 7. To release information including the student’s name and address,
     telephone number and parents’ names, address(es), cell phone
     number(s), and e-mail address(es) for a school directory that is
     prepared at school and given to all parents.

 8. To keep my child in school in the event of an emergency that poses a
     threat to the school or New York City.




Print Parent/Guardian Name               Parent’s Signature                      Date
                                             187-30 Grand Central Parkway
                                            Jamaica Estates, New York 11432
                                                     718-264-2931
                                          http://www.summitschoolqueens.com

           PLEASE COMPLETE BOTH SIDES OF THIS FORM

                     DIGITAL MEDIA CONSENT FORM
                                       2011/2012


Student’s Name: _____________________________           Date of Birth: _________



PUBLISHING TO THE WORLD WIDE WEB

Your childʼs work may be considered for publication on the World Wide Web. Such
publishing requires parent/guardian permission. Unidentified photos of students may
be published on school websites, illustrating student projects and achievements.

❑ I give permission for my childʼs work to be published on the World Wide Web.

❑ I do not give permission for my childʼs work to be published on the World Wide
Web.



CONSENT TO PHOTOGRAPH, FILM OR VIDEOTAPE STUDENT WORK

❑ I give permission for the participation in interviews, the use of quotes, and the
taking of photographs, movies or video tapes of my child and his/her school-related
work. I also grant The Summit School the right to edit, use and reuse said products
for non-profit purposes. I also hereby release The Summit School and its agents and
employees from all claims, demands, and liabilities whatsoever in connection with
the above.

❑ I do not give permission for the participation in interviews, the use of quotes, and
the taking of photographs, movies or video tapes of my child and his/her school-
related work.


Parent/Guardian Signature: ______________________________________________

Date: __________________
                                                 187-30 Grand Central Parkway
                                               Jamaica Estates, New York 11432
                                                        718-264-2931
                                             http://www.summitschoolqueens.com


                            LUNCH PERMISSION
                                2011/2012


Name of Student:_____________________________


Participation in the independent lunch program is a privilege for
academic work and behavior for students twelve and above who earn a
specific number of points prior to lunch. This is an integral part of
our motivational program.

If your child has your permission to participate in the independent
lunch program and meets the requirements, then lunch privileges will be
awarded on a day-to-day basis.

Please sign the permission form and indicate if your child has
permission to participate in the lunch program. The program will begin
on the second day of school for returning students. We will notify
incoming students about the program.




_____1.   I grant permission for my child to earn a daily, unsupervised
          lunch period.

    My child may go out to purchase lunch on Union Turnpike

    _____ With a buddy

    _____ Independently



_____2.   I do NOT want to have my child participate in an independent
          lunch program.




Signature of Parent/Guardian:_____________________________
                                     187-­‐30	
  Grand	
  Central	
  Parkway	
  
                                       Jamaica	
  Estates,	
  NY	
  11432	
  
                                                 718-­‐264-­‐2931	
  
                                 http://www.summitschoolqueens.com	
  
                    	
  
	
  
           SWIM QUESTIONNAIRE - 2011/2012 SCHOOL YEAR
             TO BE COMPLETED BY NEW ADMISSIONS ONLY


1.     Does your child know how to swim? _____________________


2. Has your child received formal swim instruction other
than at The Summit School? If yes, where? _________________

___________________________________________________________

3. Has your child passed any American Red Cross swimming
tests?

       If yes, which tests? __________________________________

___________________________________________________________


4. Would you like your child to participate in a swimming
program taught and supervised by a certified American Red
Cross Swim Instructor? ____________________________________


5. Does your child have any physical or health related
concerns pertaining to swimming of which we should be
aware? ____________________________________________________




I GIVE MY CHILD ________________________________________
PERMISSION TO
                    (Please print student's name)

PARTICIPATE IN A SWIM PROGRAM AT THE SUMMIT SCHOOL.


Parent’s Signature: _______________________________________

Date: ___________________
                                 JOIN THE SUMMIT PARENTS’ ASSOCIATION
                          AND HELP CREATE SPIRIT AND COMMUNITY IN OUR SCHOOL

2011/2012 Annual Membership
We count on your membership and your dues to fund the many activities we organize throughout the year, including:

           • Social, sporting and cultural events for our children                                   • Spring family picnic
           • Social gatherings for parents                                                           • Parent education programs.
           • Staff Appreciation events

Dues: Annual PA dues are $80.00 per family. We are aiming for 100% family participation. Please take a few minutes and sign up online (preferred method).

Volunteering: The success of the Summit PA’s programs depends not only on the annual dues but also on the participation of our parent volunteers. Parental
involvement brings home and school closer together and helps create a feeling of community among parents. We are always looking for extra help and fresh talent for
our many and varied activities. There are a number of different opportunities and ways to help. Please take a moment to check off one or more PA activities below.


How to Register and Pay:

Two registration and payment methods are available, however, we encourage you to use our online system.

1. Go to http://www.summitschoolqueens.com. Click on the Parents’ Association link for registration and payment.
   OR
2. Complete this form and submit it with your payment (check payable to The Summit PA) to the Summit School PA, 187-30 Grand Central Parkway, Jamaica Estates,
NY 11432.

Questions? Email the PA at pa@summitqueens.com.


Registration Information

Parent’s Name(s): _______________________________________________________________________________________________________________________

Primary Email: ______________________________@____________________________ Preferred phone number: (_________) __________-___________________

Child’s Name: __________________________________________________                     ☐Upper School      ☐Lower School      Class Number (if known) ________

If you have a second child at Summit, please provide the same details for him/her.

☐My contact details can be given to other parents.

Volunteering

Which committees or activities are you interested in participating in this year? (You may check as many categories as you like.)

           Annual Benefit (Assists with the November annual fund-raiser.)
           After School Program (Works with school to create new activities.)
           Class Parent Coordinator (Coordinates contact with the Class Parents of the Lower School and Upper School.)
           Class Parent (Keeps parents informed about upcoming events and organizing class socials for parents.)
           Communication & Technology (Facilitates communication between home and school; coordinates PA section of the weekly eBlast and Web site.)
           Life After Summit (Organizes educational speakers, workshops, and fairs e.g., College Fair, Summer Internship Fair, for our US parents.)
           Life At Summit (Organizes educational speakers and workshops for parents in both schools.)
           Lower School Book Fair (Coordinates and supervises this annual November event.)
           Lower School Picnic (Organizes annual June picnic at Cunningham Park.)
           Moving Up Activities (Coordinates annual June breakfast ceremony and field trip for Lower School students moving up to the Upper School.)
           School Spirit (Organizes Lower School and Upper School social activities including; Movie Night, Comedy Night, Bowling, and sports events.)
           Staff Appreciation Fund (Collects donations for staff holiday gifts in December.)
           Yoga (Helps to coordinate school Yoga program for students and teachers.)
           Other Projects (For example, parents’ survey, one off social events or activities)

Do you have any relevant skills, experience or areas of interest? (e.g., fundraising, website/computers, graphic design, event coordination)
_______________________________________________________________________________________________________________________________________

Do you have any contacts such as caterers, venue providers, performers, and ticket providers who may be able to help the PA/school? If so, please list them below, or
contact the PA at pa@summitqueens.com.
_______________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________

We look forward to working with you!
	
  

              Program	
  Calendar	
                                                  September	
  19,	
  2011	
  –	
  January	
  12,2012	
  


                          September 2011                                                                    October 2011
              S           M        T        W           T         F         S                  S           M         T         W       T       F        S
                                                        1         2         3                                                                           1
              4           5        6        7           8         9         10                 2           3         4         5       6       7        8
              11          12       13       14          15        16        17                 9           10        11        12      13      14       15
              18          19       20       21          22        23        24                 16          17        18        19      20      21       22
              25          26       27       28          29        30                           23          24        25        26      27      28       29
       	
                                                                                      30          31
                                                                                        	
  
                                                                  November 2011
                                                        S         M         T         W                T        F         S
                                                                            1          2               3        4         5
                                                        6         7         8          9              10        11        12
                                                        13        14        15        16              17        18        19




                                                 	
  
                                                        20
                                                        27
                                                                  21
                                                                  28
                                                                            22
                                                                            29
                                                                                      23
                                                                                      30
                                                                                                      24        25        26
                                                                                                                                                                                 REAP
                              December 2011                                                                     January 2012
                     S        M         T       W            T         F         S                    S        M         T         W       T        F       S          Recreational	
  Enrichment	
  	
  
                                                             1         2         3                    1        2         3         4       5       6        7
                                                                                                                                                                        After-­‐School	
  Program	
  
                     4         5        6        7           8         9         10                   8        9      10        11      12      13       14
                     11
                     18
                              12
                              19
                                       13
                                       20
                                                14
                                                21
                                                             15
                                                             22
                                                                       16
                                                                       23
                                                                                 17
                                                                                 24
                                                                                                      15
                                                                                                      22
                                                                                                            16
                                                                                                            23
                                                                                                                      17
                                                                                                                      24
                                                                                                                                18
                                                                                                                                25
                                                                                                                                        19
                                                                                                                                        26
                                                                                                                                                20
                                                                                                                                                27
                                                                                                                                                         21
                                                                                                                                                         28
                                                                                                                                                                                       Fall	
  2011	
  
                     25       26       27       28           29        30        31                   29    30        31
              	
                                                                               	
                                                               Larry	
  Litwack	
  
         The	
  Summit	
  School	
                                                                                                                              Program	
  Coordinator	
  
         187-­‐30	
  Grand	
  Central	
  Parkway	
                                                    Shaded	
  dates	
  indicate	
  REAP	
                     718-­‐264-­‐2931	
  x219	
  
         Jamaica	
  Estates,	
  New	
  York	
  11432	
  
                                                                                                      is	
  in	
  session.	
                                    Email:	
  llitwack@summitqueens.com	
  
         http://www.summitschoolqueens.com	
  
	
  
                                                                                                                                                   	
  
          Course	
  Descriptions	
                                                                                                                        Fall	
  2011	
  
                                                                                                                                                          	
  


         Cartooning	
  &	
  Illustration	
  (Mon.)	
  Christian	
  Torres	
                                                                                      Performing	
  Arts	
  (Mon.)	
  Marie	
  O’Connell	
  &	
  Tom	
  Schaefer	
  
                                                                                                                                                                  There	
  will	
  be	
  an	
  open	
  cast	
  call	
  for	
  actors,	
  dancers,	
  singers,	
  narrators,	
  artists,	
  
          Christian	
  has	
  taught	
  at	
  the	
  Riverdale	
  Country	
  School	
  and	
  is	
  currently	
  a	
  
                                                                                                                                                                  stage	
  managers	
  and	
  costume	
  designers	
  to	
  collaborate	
  on	
  a	
  REAP	
  presentation	
  
          freelance	
  illustrator.	
  Students	
  will	
  learn	
  to	
  create	
  cartoon	
  characters	
  and	
  comic	
  
                                                                                                                                                                  of	
  a	
  popular	
  musical	
  production	
  at	
  the	
  end	
  of	
  the	
  semester.	
  
          strips	
  with	
  coordinating	
  illustrations	
  or	
  freehand	
  workshops.	
  Various	
  
          techniques	
  and	
  mediums	
  will	
  be	
  explored.	
  	
                                                                                          Photography	
  Club	
  (Tues.)	
  Joan	
  Simone	
  
                                                                                                                                                                  Join	
  Joan	
  Simone	
  in	
  the	
  digital	
  photography	
  club.	
  Learn	
  how	
  to	
  use	
  a	
  digital	
  
        Computer	
  Graphics	
  &	
  Animation	
  (Tues.)	
  Corey	
  Frankel	
                                                                                   camera	
  to	
  take	
  a	
  variety	
  of	
  different	
  pictures.	
  At	
  the	
  end	
  of	
  this	
  semester,	
  you	
  
          This	
  course	
  will	
  introduce	
  students	
  to	
  the	
  basic	
  principles	
  of	
  computer	
  graphics	
                                     will	
  create	
  your	
  own	
  photo	
  book	
  as	
  a	
  keepsake	
  or	
  as	
  a	
  gift	
  for	
  someone	
  special.	
  
          and	
  animation.	
  Using	
  a	
  variety	
  of	
  techniques	
  and	
  methods,	
  students	
  will	
  create	
                                      Science	
  Club	
  (Thurs.)	
  Joan	
  Simone	
  
          both	
  vector	
  and	
  pixel	
  based	
  graphics	
  and	
  will	
  learn	
  the	
  fundamentals	
  of	
  Adobe	
                                     Wanted:	
  	
  Students	
  who	
  like	
  to	
  experiment	
  and	
  have	
  fun.	
  If	
  you	
  enjoy	
  doing	
  
          Flash.	
                                                                                                                                                science	
  experiments	
  and	
  solving	
  problems,	
  this	
  is	
  the	
  club	
  for	
  you!	
  Join	
  Joan	
  
                                                                                                                                                                  Simone	
  for	
  a	
  fun-­‐filled	
  afternoon	
  of	
  exploring.	
  We	
  may	
  even	
  make	
  an	
  
        Art	
  Class	
  (Thurs.)	
  Marla	
  Kleinman	
  
                                                                                                                                                                  experiment	
  that	
  you	
  can	
  eat.	
  
        	
  Students	
  will	
  learn	
  different	
  art	
  mediums.	
  The	
  interests	
  of	
  the	
  group	
  will	
  
        )	
                                                                                                                                                      Sports	
  Club	
  (Tues.	
  &	
  Thurs.)	
  Larry	
  Litwack	
  &	
  John	
  Obraitis	
  
            determine	
  what	
  we	
  choose.	
  This	
  is	
  a	
  list	
  of	
  all	
  the	
  things	
  that	
  we	
  can	
  do:	
  Color	
  
                                                                                                                                                                  A	
  variety	
  of	
  sports	
  are	
  selected	
  by	
  the	
  students	
  to	
  play	
  during	
  each	
  session.	
  A	
  
         mixing,	
  water	
  color	
  techniques,	
  Japanese	
  brush	
  painting,	
  calligraphy,	
  
                                                                                                                                                                  combination	
  of	
  teamwork,	
  skills,	
  and	
  strategy	
  are	
  developed.	
  From	
  dodge	
  ball	
  
         weaving,	
  embroidery,	
  sewing,	
  knitting	
  fabric,	
  shoe	
  painting	
  and	
  stained	
  glass.	
  
                                                                                                                                                                  and	
  floor	
  hockey	
  to	
  basketball	
  and	
  baseball,	
  all	
  have	
  fun	
  in	
  a	
  non-­‐competitive	
  
        Dance	
  &	
  Choreography	
  (Tues.)	
  Tara	
  Pino	
  
                                                                                                                                                                 Tennis	
  Club	
  (Thurs.)	
  John	
  O’Braitis	
  	
  
        This	
  course	
  will	
  introduce	
  students	
  to	
  a	
  variety	
  of	
  dance	
  styles	
  that	
  include	
  but	
  are	
  
        not	
  limited	
  to	
  ballet,	
  jazz,	
  and	
  hip-­‐hop.	
  Students	
  will	
  not	
  only	
  learn	
  new	
  dance	
                               The	
  Cunningham	
  Tennis	
  Center	
  houses	
  this	
  program.	
  Students	
  are	
  transported	
  
        routines	
  but	
  will	
  also	
  be	
  encouraged	
  to	
  choreograph	
  their	
  own	
  routines,	
  which	
                                          and	
  supervised	
  by	
  John	
  O’Braitis,	
  an	
  experienced	
  tennis	
  player.	
  There	
  are	
  four	
  
        they	
  will	
  have	
  the	
  opportunity	
  to	
  share	
  with	
  their	
  peers.	
  Come	
  join	
  the	
  fun!	
  
                                                                                                                                                                 Weights	
  	
  (Tues.	
  &	
  Thurs.)	
  Dennis	
  Moeller	
  	
  	
  NEW	
  
        Guitar	
  Workshop	
  (Thurs.)	
  Marie	
  O’Connell	
  
                                                                                                                                                                 Students	
  will	
  work	
  out	
  in	
  our	
  new	
  state-­‐of-­‐the-­‐art	
  fitness	
  room.	
  Students	
  will	
  
         Do	
  you	
  want	
  to	
  learn	
  guitar	
  and	
  play	
  your	
  favorite	
  songs?	
  Join	
  Marie	
  O’Conell	
  
                                                                                                                                                                 receive	
  cardiovascular	
  and	
  weight	
  training	
  while	
  learning	
  how	
  to	
  use	
  our	
  new	
  
         for	
  this	
  unique	
  guitar	
  workshop.	
  We	
  will	
  cover	
  guitar	
  playing,	
  voice	
  
                                                                                                                                                                 treadmills,	
  ellipticals,	
  bikes,	
  weight	
  machines,	
  and	
  free	
  weights.	
  A	
  training	
  
                                                                                                                                                                 program	
  will	
  be	
  tailored	
  to	
  meet	
  the	
  individual	
  needs	
  of	
  each	
  student.	
  Space	
  is	
  
       Magic,	
  Yu-­‐Gi-­‐Oh,	
  Bakogan,	
  Legos	
  &	
  More!	
  (Thurs.)	
  Sherri	
  Bordoff	
  
         Come	
  join	
  our	
  students	
  as	
  they	
  play	
  and	
  compete	
  in	
  a	
  variety	
  of	
  exciting	
  and	
  
         current	
  card	
  games.	
  Demonstrate	
  your	
  knowledge	
  and	
  share	
  your	
  skills.	
  Make	
                                        Chess	
  Intermediate/Advanced	
  	
  (Mon.	
  &	
  Thurs.)	
  Matthew	
  Looks	
  
         new	
  friends	
  with	
  others	
  who	
  share	
  your	
  interests!	
  
                                                                                                                                                                  We	
  are	
  offering	
  something	
  very	
  special	
  to	
  a	
  select	
  group	
  of	
  students.	
  If	
  you	
  
                                                                                                                                                                  would	
  like	
  your	
  child	
  to	
  learn	
  chess	
  from	
  a	
  member	
  of	
  our	
  staff,	
  Matthew	
  
                                                                                                                                                                  Looks,	
  who	
  is	
  a	
  National	
  Chess	
  Master,	
  please	
  sign	
  up	
  immediately.	
  This	
  
                                                                                                                                                                  intermediate	
  to	
  advanced	
  chess	
  course	
  is	
  designed	
  to	
  provide	
  guidance	
  and	
  
                                                                                                                                                                  strategy	
  for	
  those	
  who	
  know	
  the	
  rules	
  of	
  the	
  game.	
  
September 19, 2011 – January 12, 2012                                            3:00 p.m. – 4:30 p.m.

 THE RECREATIONAL ENRICHMENT AFTER-SCHOOL PROGRAM (REAP)

                             Fall 2011 REGISTRATION FORM

Student Information:

Last Name: ________________________________              First Name: _______________________

Date of Birth: ______________________________            Class: ___________

Address: ______________________________________________________________________________

Phone: ___________________________


Parent/Guardian Information:
Name: ___________________________________       Cell Phone: ____________________________

Day Phone: _______________________________      Fax: __________________________________

Email: _________________________________________________




Transportation Information: Dismissal is at 4:30 pm. Parents must arrange transportation home.

Indicate your transportation plans below.

❑ I will pick up my child.                                        ❑ My child will travel home independently.

❑ My child will be picked up by _________________________________________

❑ I need car pool information. (Destination) ________________________________

❑ I am interested in private bus service or car service. (Depending on need).

Medical Information: Medication is administered between 3:00 pm and 4:30 pm.
 TIME                   NAME OF MEDICATION                                   DOSAGE




Allergies
         ❏ Food: _________________________               ❏ Insect Bites: ______________________
         ❏ Medication: ____________________              ❏ Other: ___________________________

Does your child require the administration of an EpiPen during a severe allergic reaction?
                  ❏ Yes ❏ No                 Administered By: ❏ Staff ❏ Student

Medical Alerts
        ❏ Asthma             Does your child require the use of an inhaler? ❏ Yes ❏ No
                             Administered by: ❏ Staff ❏ Student

         ❏ Glasses           ❑ Seizure Disorder          ❑ Other: ____________________________


                                                                                               OVER
       AFTER-SCHOOL ACTIVITY SELECTIONS: INDICATE 1ST AND 2ND CHOICE OF ACTIVITY

                                              For more information, please contact:

                                                Larry Litwack at 718-264-2931 x219
                                                Email: llitwack@summitqueens.com

               ACTIVITY                            MONDAY         TUESDAY             THURSDAY           SUBTOTAL
                                                   13 SESSIONS    16 SESSIONS           14 SESSIONS
CARTOONING & ILLUSTRATION                         1 2
                                                 Fee: $425.00*
COMPUTER GRAPHICS &                                               1 2
ANIMATION                                                        Fee: $425.00*
ART CLASS                                                                              1 2
                                                                                    Fee: $375.00
DANCE & CHOREOGRAPHY                                               1 2
                                                                  Fee: $350.00
GUITAR WORKSHOP                                                                        1 2
                                                                                    Fee: $425.00*
MAGIC & MORE                                                                           1 2
                                                                                    Fee: $375.00*
PERFORMING ARTS                                    1 2
                                                 Fee: $450.00*
PHOTOGRAPHY CLUB                                                  1 2
                                                                 Fee: $400.00*
SCIENCE CLUB                                                                           1 2
                                                                                    Fee: $425.00*
SPORTS CLUB                                                       1 2                1 2
                                                                 Fee: $375.00*       Fee: $350.00*
TENNIS CLUB                                                                            1 2
                                                                                    Fee: $475.00*
WEIGHTS- BRAND NEW                                                1 2                1 2
         WEIGHT ROOM!                                            Fee: $375.00*        Fee: $350.00*

CHESS INTERMEDIATE/ADVANCED                        1 2                                1 2
                                                 Fee: $400.00                          Fee: $400.00

* Material Fee Included.
Please make your check payable to: Summit School Enrichment.                           Subtotal:
Return this form and payment to: The Summit School Attn: REAP                                              + $30.00
187-30 Grand Central Parkway, Jamaica Estates, NY 11432                         Registration Fee:

                                                                                           Amount Due:




       PARENT PERMISSION:

       ❏ I give permission for my child to participate in REAP.


       Parent’s Signature: ____________________________                                    Date: ____________

				
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