After School by wuxiangyu

VIEWS: 22 PAGES: 13

									After
School
      E tras
         Fall 2006

Fun and learning don’t
have to end when the school
bell rings!

PA’s EXTRAS program features after-
school activities that allow children to
pursue and expand upon special interests
ranging from basketball to dancing to
mad science!


Don’t delay in reserving a spot in one of
these exceptional classes! Return the enclosed
registration form to your grade level office.



               For more information, contact
               Tiffany Knight:
                                           tiffany.knight@pulaskiacademy.org
                                           501.604.1907
After School
EXTRAS                                                                         Fall 2006



Adventures Under the Sea
Cost: $120, Supply Fee: $15
Grades: 2nd – 3rd
Time & Date: 3:30 - 4:30, Tuesdays, September 5 - December 5 (no class October 17 &
November 21)
Location: LS35
Instructor: Toni Moutos

Come along with us as we discover the treasures of the sea! This class will incorporate
reading, writing, math, and science skills. We will read about the whale shark and
measure how long it really is! We’ll expore whether an egg floats better in salt
water or fresh. We’ll also read true stories about the seahorse, find out what
color an octopus turns when he gets mad, and discover which shark would be
best at helping to make cookies!


An American Girl Halloween
Cost: $25, Supply Fee: $15


              ED
Grades: K - 2nd



           OS
Time & Date: 3:30 - 6:00, Wednesday, October 25 (**PLEASE NOTE CHANGE IN DATE!**)
Location: Lower Gym


CL
Instructor: Patti Coleman, Jane Ann Fortenberry, Kay Jones

Bring your “American Girl Doll” (or any doll about the same size) and join us in celebrating Halloween with Molly!
Your child will make her very own doll a costume, create Halloween accessories, play games, and have a tasty treat.
Experience an afternoon of “old-fashioned” Halloween fun with your American Girl Doll, Mrs. Coleman, Mrs. Jones
and Mrs. Fortenberry! ….Sign up soon!


Back to School Bash!
Cost: $25, Supply Fee: $15
Grades: K - 3rd
Time & Date: 3:30 - 6:00, Wednesday, September 6 (K & 1st), Thursday, September 7 (2nd & 3rd)
Location: Lower Gym
Instructor: Patti Coleman, Jane Ann Fortenberry, Kay Jones

Calling all Bruins! Join us for an afternoon of back-to-school fun! Activities will include creating a special gift for your
new teacher, designing a “spirit” t-shirt, making luggage tags for your backpack and lunch box, and many more excit-
ing activities! Visit with new friends and old friends! We will have a Bruin blast! Sign up soon!!




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Basketball Training Academy
Cost: $60, Supply Fee: $5
Grades: 1st – 6th
Time & Date: Session 1: 3:30 - 4:30, Wednesdays, September 6, 13, 20, 27, October 4, 11
Location: Upper Gym
Instructor: Chuck Winkelman

Join Coach Winkelman and the Bruin Senior High players for basketball skill development and fun games. What a
great way to start the school year as we get ready for another great year of hoops at PA!
(The students will be split up according to age groups.)


Cheetah Girls
Cost: $25, Supply Fee: $15
Grades: PK4 - 4rd
Time & Date: 3:30 - 6:00, Wednesday, November 29
Location: ECC Building
Instructor: Patti Coleman, Jane Ann Fortenberry, Kay Jones

Let the party begin, Cheetah Girls!! Join Mrs. Jones, Ms. Fortenberry, and Mrs. Coleman
for a fun-filled cheetah afternoon! We will sing cheetah songs, make cheetah crafts, and
have a cheetah-licious snack!


Christmas Cookie Exchange
Cost: $25, Supply Fee: $15
Grades: PK4 - 3rd
Time & Date: 3:30 - 6:00, Tuesday, December 5
Location: Lower Gym
Instructor: Patti Coleman, Jane Ann Fortenberry, Kay Jones

Calling all Santa’s helpers! Experience an “old-fashioned” cookie exchange. We will bake and exchange Christmas cook-
ies, decorate a special cookie box, and enjoy Christmas magic!


Clay Mates
Cost: $139 (9 sessions); Supply Fee: $15
Grades: 4th – 7th
Time & Dates: 3:30 - 5:00; Tuesdays, September 5 - November 7 (no class October 31)
Location: SA110
Instructor: Shirley Howard

Students will use clay to create a “clay mate.” The clay mate is the combination of an animal and human. The mate
will have the clothes and expression of a human but will have all other characteristics of an animal. Join this class to
create a “mate” that will last a lifetime!




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Creative Kids Beginning Drawing, Part I
Cost: $ 150; Supply Fee: $30
Grades: K – 2nd
Time & Dates: 3:30 - 5:00, Tuesdays, September 19 – December 12 (no class October 17 & 24, November 21)
Location: LS36
Instructor: Carol Furr

Get ready for fall (and a refrigerator plastered with color and creativity!) Join artist Carol Furr in a step-by-step instruc-
tional art class designed to build confidence in your child’s abilities. Kids can’t learn to play the piano or become skilled
at a sport, for example, without witnessing the basic components. And art is no different! Students will learn how to
select supplies and a proper work space, as well as prime objects to draw. Each week, these beginning classes will couple
core art concepts with kids’ creativity and imagination, enabling them to produce their own mini-
masterpieces. Come join the fun!


Creative Kids Beginning Drawing, Part II
Cost: $ 150; Supply Fee: $30
Grades: 1st – 3rd (prerequisite Beginning Drawing Part I)
Time & Dates: 3:30 - 5:00, Thursdays, September 21 - December 14 (no class October 19 & 26, November 23)
Location: LS36
Instructor: Carol Furr

So your child has finished Creative Kids Part I and loved it! Now what? Your child can take his/her talent to the next
level with Part II of the curriculum! Join instructor Carol Furr for another round of step-by-step art classes designed
to boost your child’s confidence and abilities. This class will build upon the concepts learned in Creative Kids Drawing
Part I, giving students the confidence to draw on their own. Clean off your refrigerators, parents! A new round of mini-
masterpieces is coming your way!


Computer Quest
Cost: $140 (14 sessions) Supply Fee: $15
Grades: 3 year olds - 1st grade
Time & Date: 3:15 - 4:00, Wednesdays, September 6 –
December 13 (no class November 22)
Location: ECC Building (Roger’s room)
Instructor: Melissa Anthony

Choose an extracurricular activity that your child will enjoy while also improving his/her readiness for school! This
course is filled with computer adventures designed to strengthen creativity and improve thinking and memory skills,
all while having a great time! Computer Quest’s primary goals are to:

       Teach proper respect & handling of computers
       Improve mouse control
       Become familiar with the keyboard
       Build self-esteem as each skill level is mastered
       HAVE FUN!!!

Using educational software, art projects, and hands-on activities, the Computer Quest curriculum is specifically de-
signed for children 3 years old – 1st grade. Give your child the computer skills he or she needs to succeed!

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Computer Whiz Kids
Cost: $80 (for four two-hour sessions); Supply Fee: $15
Grades: 2nd – 4th



               ED
Time & Date: 3:30 - 5:30 each session, Tuesdays, October 10 & 24 and November 7 & 14
Location: LS Think Tank Room


            OS
Instructor: Keri Bone



CL
Maximum Enrollment: 24 students

Are you a whiz at computers? Would you like to be? Then join Computer Whiz Kids starting next month to build your
basic and intermediate skills using a laptop computer. You’ll learn to use a scanner, learn special laptop skills, save and
import files to specific locations, and put your creativity to the test! In Computer Whiz Kids, you’ll get to use a variety
of fun software to design pictures, birthday or greeting cards, stickers, address labels and even make your own personal-
ized 12-month photo calendar to keep or give as a gift! This is a great after school class that will put you ahead of the
pack as you become a true Computer Whiz Kid!


Dance with Denise White, PK4 - Kindergarten
Cost: $120 (12 weeks), Supply Fee: $10
Time & Dates: 3:30 – 4:30, Wednesdays, September 6 – December 7 (no class October 18 and November 22)
Grades: PK4 – Kindergarten
Location: MS51
Instructor: Denise White

Dancing with Mrs. White will provide an opportunity to gain confidence along
with learning ballet and tap dancing. Students will learn dance techniques and cute
routines to show off at the end of the session (and hopefully in the PA talent show!) These
students will perform in the recital for Little Rock School of Dance.


Dance with Denise White, 1st - 2nd grade
Cost: $180 (12 weeks), Supply Fee: $10
Time & Dates: 3:30 – 5:00, Tuesdays, September 5 – December 6 (no class October 17 and November 21)
Grades: 1st – 2nd
Location: MS51
Instructor: Denise White

Dancing with Mrs. White will provide an opportunity to gain confidence along with learning ballet, jazz, and tap.
Students will learn dance techniques and cute routines to show off at the end of the session (and hopefully in the PA
talent show!) These students will perform in the recital for Little Rock School of Dance.


The Detective Club, 3 one-day session classes
Cost: $15 (each session), Supply Fee: $3 (each session)
Grades: 2nd – 4th
Time & Date: 3:30-5:00
Location: LS Think Tank Room
Instructor: Keri Bone
Maximum Enrollment: 24 students per session


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Do you love a good “Who Done It?” Are you intrigued by mysteries? Join Mrs. Bone and members of the Detective
Club as we solve three fun mysteries this semester. You young thinkers out there will get an opportunity to solve deduc-
tive logic puzzles, decode messages, sort information, and use inference as you solve the mysteries. The Detective Club
will offer you a class that’s great fun by being a classroom detective and will sharpen your thinking skills, too! You may
sign up for individual classes or all three. Four more Detective Club mysteries will be presented in the spring!

Class 1: Welcome to the Detective Club – Can you pass the tests to be a new member?
Thursday, October 12
This introductory session gives young detectives the opportunity to work on the logic matrix puzzles that are seen
throughout The Detective Club mysteries. There are more mystery surprises in store for you, too!

Class 2: The Case of the Lost Backpack
Thursday, November 16
Detectives will help find the owner of a backpack that was left on the soccer field. To solve the mystery, young detectives
will analyze a variety of information and use the process of elimination to solve the mystery!

Class 3: The Case of Santa’s Gift List
Thursday, December 7
Ho! Ho! Ho! When a strong wind blows Santa’s gift list out of his hand while delivering Christmas gifts on Christmas
Eve, he needs some fast help from the Detective Club to get the gifts delivered to the right houses. The young detectives
will use logic and deductive reasoning to solve this holiday mystery!


Discovering Great Artists, 3 one-day
session classes
Cost: $20 (each session), Supply Fee: $10 (each session)
Grades: 1st – 4th
Time & Date: 3:30-5:30
Location: LS Think Tank Room
Instructor: Keri Bone
Maximum Enrollment: 24 students per session

Do you love art? Do you enjoy learning about great artists? Would you like to try to
create works of art like some of the great masters? Discovering Great Artists is for YOU!!!! See the class descriptions
below to find out how you can take part in the fun of Discovering Great Artists! You may sign up for individual classes
or all three. Four more Discovering Great Artists classes will be presented in the spring!

All participating artists get to take home most of their art supplies at the end of each class!

Class 1: Picasso Possibilities!
Thursday, September 28
Join us as we explore abstract art and cubism in the style of the Spanish painter, Pablo Picasso. You’ll make a wild and
wacky self-portrait in a cubism style just like Picasso would have done. Join us as we discover Picasso Possibilities!

Class: 2: Sensational Cezanne!
Thursday, November 2
Join us as we get a little “fruity” with Paul Cezanne! We’ll learn about this French Post-impressionist painter and do
still life chalk drawings like this great master. This is one work of art you’ll enjoy sinking your teeth into!



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Class 3: Radical Radko!
Thursday – November 30
Just in time for Christmas – we’ll create holiday works of art like contemporary artist, Christopher Radko. We’ll start off
painting glass ornaments with very special paints then make another holiday work of art just like Mr. Radko himself!
Take your artwork straight from class to your Christmas tree!


Handwriting without Tears: CURSIVE
Cost: $120 (12 weeks), Supply Fee: $15
Grades: 3rd - 5th
Time & Dates: 3:30 - 4:30, Mondays, September 18 - December 11 (no class November 20)
Location: LS9
Instructor: Vicki Prindle, M.S.E.

Can’t read your child’s handwriting? Try this multisensory, developmentally-based handwriting method that has proven
to work for children of all abilities. The innovative games and directions are simple and clear, as is the letter formation
style.


Kids Cook Iron Chef TM

Cost: $20, Supply Fee: $10
Grades: Kindergarten - 2nd grade
Time & Date: 3:30 - 5:30, Tuesday, October 3
Location: Lower Gym
Instructor: Donna Horton and Faith Anaya (a.k.a. Mrs. Goldberg)

Two teams! One secret ingredient! What will each team make? Which team will win?
                          ***Remember YOU may be the next IRON CHEF @ P.A.!!!!!***
                                    A ONE TIME ONLY SPECIAL EVENT!


Mad Science 3, Session A
Cost: $60, Supply Fee: $25
Grades: 1st – 4th
Time & Dates: 3:30 - 5:00, Monday through Thursday, September 25 - 28
Location: SA203
Instructor: Doug Reed

Make After School an awesome science adventure! Students will conduct hands-on ex-
periments using acids and bases, will investigate the building blocks of the universe, and
will voyage through space to discover planets, comets, and more! Take-homes include:
Canister Cannon that pops using an acid and a base, Roto-Rocket Space Shuttle that
really flies, and ooey, gooey, Mad Science Silly Putty.




                                                                                                                              6
Mad Science 3, Session B
Cost: $60, Supply Fee: $25
Grades: 1st – 4th
Time & Dates: 3:30 – 5:00, Monday through Thursday, October 23 - 26
Location: SA203
Instructor: Doug Reed

Add some Science Excitement to After School!! Through hands-on experiments and science videos, students will explore
the properties of electricity, the exciting science of Chemistry, and the fun deceptions of optical illusions. Take homes
include: Electroscope that repels like charges, Crystal Garden that grows, and Periscope that explains the concept of
reflection.


Nostalgic Recipe Book!
Cost: $30, Supply Fee: $25
Grades: 3rd – 6th
Time & Dates: 3:30 - 5:00, Wednesdays, October 4 and 11
Location: Lower School Computer Lab
Instructor: Christine Bennett
Maximum Enrollment: 15 students

Are you looking for a unique holiday gift for someone special? If so, come create one filled with family recipes to re-
member and keep for life! Use the computer to create a nifty cookbook for someone you love! Bring 10 of your favorite
recipes and turn them into a treasure! Also, bring a picture of the author (you)!


PA Kids Cook!, K - 1st grade
Cost: $75, Supply Fee: $18
Grades: K - 1st
Time & Dates: 3:30 - 5:00, Tuesdays, October 10 – November 14 (no class
October 17)
Location: Lecture Hall
Instructor: Faith Anaya and Donna Horton
Maximum Enrollment: 12 students

New Recipes! New Foods! More Fun! Classes combine fun, eating, and learning. Much more than just stirring, our
emphasis is on skills, independence, and nutrition with a goal of involving kids in the family food-making process.


Rowdy Boys
Cost: $20, Supply Fee: $15
Grades: 3rd – 5th
Time & Date: 3:30 – 5:30, Wednesday, October 11th
Location: Mrs. Scott’s Room
Instructor: Glenda Scott

Boys, it’s your turn! Come and join the guys for some good, clean fun doing experiments, making “stuff” guys like, and
playing games. No girls allowed for this class!


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Santa’s Secret Workshop
Cost: $20, Supply Fee: $15
Grades: K – 4th
Time & Date: 3:30-5:30, Wednesday, December 6
Location: Lecture Hall
Instructor: Bethany Jennings
Maximum Enrollment: 20 students

Join Mrs. Jennings and friends as we visit and play inside Santa’s Secret Workshop here at Pulaski Academy! Enjoy
eating Christmas cookies, making ornaments, learning more about Santa’s workshop and his elves, singing Christmas
carols, playing reindeer games, and much more. So join the fun and come visit Santa’s Secret Workshop! This is one
Christmas season you won’t forget.


Shurley English Review
Cost: $130 (13 weeks), Supply Fee: $5
Grades: 5th – 7th
Time & Date: 3:30-4:30, Tuesdays, September 5 – December 5 (no class November 21)
Location: MS24
Instructor: Beverly Harrison

Start the semester off right with a jumpstart in the Shurley Grammar Method: English Made Easy. All seven sentence
patterns will be introduced along with terminology and skill practice. This class will help students have more confidence
and success with the tools that will enable them to become better writers during their middle school years.


So, You Want to be a Star!!!
Cost: $90, Supply Fee: $50
Grades: 5th – 6th
Time & Date: 3:30-4:30, Thursdays, September 7 – November 9 (no class October 19)
Location: MS51
Instructor: Sheila Glasscock
Minimum Enrollment: 8 students

This class is for 5th and 6th graders who want to explore elements of acting for the stage. From soap operas to fairy
tales, students will have tons of fun while learning about stage movement, blocking, and basic acting techniques. Also,
students will work with hand puppets and puppet theatre to reinforce the basic elements of theatre performance.


Wicked Wednesday
                   ED
Cost: $20, Supply Fee: $15



                OS
Grades: K – 4th
Time & Date: 3:30-5:30; Wednesday, October 25th



  CL
Location: Lecture Hall
Instructor: Bethany Jennings
Maximum Enrollment: 20 students

Join Mrs. Jennings and friends to celebrate Halloween early on a “wicked Wednesday.” Together students will decorate
pumpkins, eat ghostly snacks, make scary crafts, hear spooky stories, dress up, play monster mania, and much more!
Don’t miss this very wicked Wednesday… it will BOO-licious!!!
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Private
LESSONS                                                                    Fall 2006



Private Lesson Information                                                      Cost
     All private lessons will be set up directly with the individual in-        One-hour lesson: $40
     structor.                                                                  45-minute lesson: $30
     Services will be billed monthly through the Business Office.                 30-minute lesson: $20




Private Piano Lessons
                      ED
Supply Fee: $30 per semester



                   OS
Time: Available after school Tuesdays and Thursdays



   CL Lessons
Location: SA210
Instructor: Katie Signaigo
Contact information: katie.signaigo@pulaskiacademy.org, 501.258.6560


Private Flute
Supply Fee: Will vary
Grades: 5th - 12th
Time: Mondays, 3:30-5:30 (lessons will be 30 minutes)
Location: To be determined
Instructor: Stephanie Cullen
Contact information: 501.227.8091




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Academic
TUTORING                                                                     Fall 2006



Academic Tutoring Information                                                           Cost
      All tutoring will be set up directly with the individual instructor.              One-hour lesson: $40
      Services will be billed monthly through the Business Office.                        45-minute lesson: $30
      Students may not be tutored by his/her classroom teacher for the                  30-minute lesson: $20
      current year.



2006-2007 Academic Tutors
Call or email these teachers directly to set up tutoring.

Dorcas Baumgardner                                           Bethany Jennings
Any subject                                                  Any subject
Grades: 1st - 7th                                            Grades: Kindergarten - 8th
Times: Available Mondays - Wednesdays after 3:30             Times: Available Tuesday - Thursday after 3:30
Contact: dorcas.baumgardner@pulaskiacademy.org,              Contact: bethany.jennings@pulaskiacademy.org, 663.3298
225.1612
                                                             Carol Langston
Mary Kay Burton                                              Any subject
Any subject                                                  Grades: 1st - 5th
Grades: 1st - 5th                                            Times: Available daily 3:30 - 4:30
Times: Available Monday - Thursday afternoon                 Contact: carol.langston@pulaskiacademy.org, 225.9266
Contact: mkbnonna@comcast.net, 551.5489
                                                             Linda Madden
Patti Coleman                                                Any subject
Any subject                                                  Grades: 1st - 5th
Grades: ECC - 4th                                            Times: Available daily 3:30 - 4:30
Times: Available daily 3:30 - 4:30 or 4:30 - 5:30            Contact: linda.madden@pulaskiacademy.org, 993.7776
Contact: patti.coleman@pulaskiacademy.org, 223.8833
                                                             Elaine McKinney
Jennifer Corbin                                              Any subject
French                                                       Grades: Kindergarten - 4th
Times: Available daily after school                          Times: Available daily 3:30 - 4:30 or 4:30 - 5:30
Contact: jennifer.corbin@pulaskiacademy.org, 454.7852        Contact: elaine.mckinney@pulaskiacademy.org, 224.3135

Beth Cottrill                                                Glenda Scott
Math, French through Level 4, US Science, English            Language Arts
Grades: MS - US                                              Grades: 1st - 4th
Times: Available weekdays 5:00 - 8:00 & all day Saturday     Times: Available Tuesdays - Thursdays, 3:30 - 4:30
Contact: elizabeth.cottrill@gmail.com, 615.545.7226          Contact: glenda.scott@pulaskiacademy.org

Annis Hill                                                   Kathey Wilburn
Organization, Study Skills, Time Management                  Intro Pre-Algebra, Pre-Algebra, Alg I, Alg II, Geometry
Grades: 1st - 4th                                            Times: Available daily after school
Times: Available daily during the a.m. or p.m.               Contact: kathey.wilburn@pulaskiacademy.org, 374.5344
Contact: annis.hill@pulaskiacademy.org, 280.9366
                                                                                                                       10
THERAPY                                                                        Fall 2006



Therapy Information
       All therapy will be set up directly with the individual instructor.
       Services will be billed monthly through the Business Office.
       Insurance is not accepted for therapy services.


Speech Therapy                                                   Phonological Awareness Course
Cost: $60/hour
Times: Call for available appointment times                      Cost: $60/hour per student for private instruction, $30
Location: To be determined                                       an hour per student for group instruction
Instructor: Lorri Yung, MA, CCC-SLP                              Times: Available a.m. or p.m.
Contact: 225.3706                                                Location: To be determined
                                                                 Instructor: Laura McNutt
Lorri Yung provides diagnostic and treatment services to chil-   Contact: 501.416.7821
dren with speech and language delays including articulation,
phonology, language, voice, fluency, and oral motor delays.       Multisensory training in sound awareness, isolation, blend-
Lorri is a certified Arkansas licensed speech-language patholo-   ing, segmenting and manipulation to form words. For
gist who has been practicing for 6 years.                        older students, this will address the structure of the English
                                                                 language and include syllable types, syllable divisions, rules,
                                                                 prefix and suffix meanings, and root words. Class size
Reading/Language Therapy                                         limited to 4 students. This therapy is individualized for each
Cost: $60/hour, Supply Cost: Purchasing of books may             student and may take from 6 weeks to 2 semesters to com-
be necessary                                                     plete, depending on the needs of the students.
Times: Individually shceduled in the a.m. or p.m.
Location: Mrs. Hill’s room in LS
Instructor: Annis Hill
Contact: annis.hill@pulaskiacademy.org, 280.9366
Reading/language therapy offers one on one multi-sensory
instruction in reading, writing, and spelling with intense
phonic instruction and phoneme practice.

Reading/Language Therapy
Cost: $60/hour per student for private instruction, $30
an hour per student for group instruction
Times: Available a.m. or p.m.
Location: To be determined
Instructor: Laura McNutt
Contact: 501.416.7821
Multisensory instruction for those struggling with reading,
writing, and spelling. Class size limited to 4 students. This
therapy is individualized for each student and may take from
6 weeks to 2 semesters to complete, depending on the needs of
the students.
                                                                                                                               11
Fall 2006 EXTRAS Registration
To enroll in PA’s EXTRAS program, please complete the following information. Return this form with the full tuition
fee to PA’s EXTRAS Program, 12701 Hinson Road, Little Rock, AR 72212. Please photocopy this form if you need
additional pages.

Student’s Name: _______________________________________ Grade: ______ Teacher: _______________
Name of Parent/Guardian: ___________________________________________________________________
Address: __________________________________________ City/State/ZIP ___________________________
Home Phone: __________________ Work Phone: __________________ Cell Phone: ____________________
E-Mail Address: ________________________________
Emergency Contact: ____________________________________ Relationship: _________________________
Home Phone: __________________________________ Work Phone: ________________________________

your choice of EXTRAS
                   Course Name                                      Course Fee                       Supply Fee                     Cost Per Class
1. ____________________________                             ________________                  _______________                  ________________
2. ____________________________                             ________________                  _______________                  ________________
3. ____________________________                             ________________                  _______________                  ________________
4. ____________________________                             ________________                  _______________                  ________________
                                                                                                       TOTAL:                  ________________
* Full tuition fees must accompany this application and are non-refundable. Full refunds will be issued if a course is cancelled due to insufficient enrollment.


Fall EXTRAS additional information
A) Authorization to Consent to Medical Treatment. In the event that I cannot be contacted to give my consent, I
hereby authorize Pulaski Academy’s officers, agents, and employees to consent to
     1. The administration of any treatment deemed available by a licensed physician or dentist, and
     2. The transfer of the minor to any hospital reasonably accessible

      Physician Name: ______________________________ Phone: _________________________
      Address: ____________________________________________________________________
B) Authorization of Administration of Medicine at School. I give my consent for my child to be administered the fol-
lowing non-prescription medication(s) by the school nurse or designated instructor.
      Acetaminophen (Tylenol) yes _____            no _____
      Ibuprofen                    yes _____       no _____
Other medicines that may be required by the student must be supplied by the parents and brought to the school in the
original container properly labeled with the name of the student and identification of the medication, the dosage, and
the time to be administered.
      My student has the following allergies: _____________________________________________

C) Permission to Pick-up Student. I give my consent to allow the following persons to pick up my child in my absence
at the end of the course/session.
      1: ________________________ 2: ________________________ 3: _________________________

Parent/Guardian Signature: _____________________________________________________

Date: ________________________________

								
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