[Apswel] Registration and consent Form for Wellness night

Mon Feb 11 11:38:07 EST 2008

Registration: West Elementary - 2nd Annual Wellness Night

February 26, 2008 - *6:00 pm to 8:00 pm (Raffle 8:00 pm to 8:30 pm) 

(Snow Date - 3/4/08)

The West El PTO Community Cares Committee presents Wellness Night for
the families of West Elementary.  This event focuses on personal
wellness for the individual and the family and new this year, some help
on keeping our planet green and healthy.  Presentations range across the
spectrum of wellness from the conventional to the complementary. Sign up
for an evening of informative and action-oriented sessions geared to
your vision of a healthy, well-balanced optimal life.

Print this registration form and consent form and fill out one copy for
each family member who is attending.  Return registrations, consents and
fees via child's backpack no later than Wednesday, 2/13/08.    

The evening's events are $5.00/family.  Refreshments provided free for
those attending. Healthy refreshments and raffle prizes donated courtesy
of local vendors. The raffle will take place after the last session in
the cafeteria.  Participants do not have to be present to win a prize.
Those not attending the drawing will be notified the next day.

Parent/Caregiver Name
___________________________________________________

Attendee Name __________________________________________________________

Attendee age (if student)
__________________________________________________

Phone number __________________________________________________________

Email address
___________________________________________________________

**Select 5 presentations per person.  Label 1 to 5 (1 = first choice
thru 5 = least choice).  Max. # of sessions/evening is 3.  Return early
for placement in your top 2-3 choices.

      Nutrition - Eating on the Run - All

* Medical Perspective - What's the Skinny on Fat!! - Adults

* Stretching - Avoid Injuries, Train Hard - All

* Kids Cooking - Kids

* Yoga - Kids

* Mrs. O'Donnell's Confident Kids - All

* Yoga - Yoga/Pilates/Tai Chi - All

* Strength Training - All

* Yoga - Intermediate/Advanced - Adults

* AVIS Trails/Hiking in Andover - Kids

* Martial Arts Intro - All

* AVIS Trails/Hiking in Andover - Adults

* Runners' Clinic-Get Set for Spring Training - All

* Bike Safety - Get Set for Spring - All

* Going Green - Local and Global - All

An Exhibit/Refreshments area will be set up in the cafeteria and is open
throughout all sessions.  Blood pressure screenings and
mini-consultations will be available there courtesy of our dedicated
school system and parent RNs and LPNs.  BMI, body composition stations
and wellness oriented vendors and exhibits will be available.  Kids,
don't forget your Wellness Calendars for extra raffle tickets!

Bonus: Receive 2 more FREE raffle tickets towards great prizes.  You are
our valuable resource.  Submit at least one suggestion for our list,
"Cheap (or free) things to do in and around Andover".  The suggestion
should encourage a healthy activity or endeavor.  All suggestions will
be reviewed and added to a list for hand out on Wellness Night.  Let us
know if we can acknowledge you for your contribution or if you wish to
remain an anonymous donor.

Acknowledge OK?              Yes         No

Suggestion
________________________________________________________________________
_____

________________________________________________________________________
______________

________________________________________________________________________
______________

________________________________________________________________________
______________

*Please come early to check in for sessions starting promptly at 6:00
pm.

**Parents, please register yourself for your child's class if you feel
supervision is necessary.

Parent Consent for Extracurricular Activities and Medical Authorization

(wellness night February 26th)

Your child is invited to participate in our extracurricular activity
program.  It is understood that "extracurricular" refers to those
activities taking place before or after school.  These programs may
include but are not limited to interscholastic sports, intramural
sports, and clubs.  Participation in these activities is voluntary, but
you must give permission before your child can participate.  Your
signature below grants your permission.  

Your child will be supervised by teachers, coaches, and/or volunteer
leaders.  Every program has certain unavoidable risks attached to it.
We cannot enumerate every risk, but we believe that you are generally
familiar with these activities and your child; therefore, you are in the
best position to decide whether your child should participate.  The
School Department and principal have approved these activities, but we
cannot and do not guarantee that there will be no injuries or damages as
a result of participation. Given the nature of some activities an
additional consent form may be required.   

By signing this form, you agree that your child may participate in
extracurricular activities.  By signing this form, you also agree to
release the Town of Andover, its School Department, elected officials,
employees, and volunteer supervisors from any and all damages, as the
result of death and/or injuries of any kind you and your child might
suffer as a result of participating in any of these activities, except
for those that result from gross negligence or wanton and willful
misconduct.  This agreement to release does not apply to any independent
contractor.

Should it be necessary for your child to have medical treatment while
participating in an activity and a parent cannot be reached, your
signature gives the school district personnel permission to use their
judgment in obtaining medical service for the child and gives permission
to the physician to render medical treatment deemed necessary and
appropriate.  You should understand that the school district has no
insurance covering such medical or hospital costs incurred for your
child; therefore, any cost incurred for such treatment shall be your
sole responsibility.

This is a legal document and you are free to obtain a lawyer's advice at
your own expense before signing it.  You may not, however, change the
language of this form, and any additions or deletions you make to this
permission and release are void.

Student's Name:
______________________________________________________________________

Parent/Guardian Signature*:
___________________________________________________________

Address:
________________________________________________________________________
______

Telephone #s:  Home - ________________  Cell - ________________  Work -
_________________  

*	If the student is 18 years or older, the student should sign
this form.

 This consent form relates to the following: Wellness Night Activities
on February 26, 2008 6-8 PM at West Elementary School.

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