back to school edition 2016 welcome ack!! · 2016-06-28 · back to school edition 2016 page 2...

Back to School Edition 2016

Principal Amy Champlin

Secretary—Kim Meller 973-8690

Assistant Principal Stephanne Seals

(7th grade M-Z, 8th grade) 973-8617

Assistant Principal Joe Nelson

(6th grade, 7th grade A-L) 973-8617

Welcome Back!! It’s hard to believe that it is time to start thinking about a new school year already, but it is just around the corner! I would like to take this opportunity to welcome you all to Robinson Middle School! We are very excited to begin the new school year! The first day of school for 6th graders is Tuesday, August 23, from 8:00-11:30. The first day of school for all students will be on Wednesday, August 24. Buses will begin running effective August 23. I am looking forward to a fantastic year at Robinson Middle School! Enjoy your final days of summer! I look forward to seeing you all soon!

6TH GRADE SNEAK PREVIEW Parents and 6th grade students are invited to drop by for our special 6th Grade Sneak Pre-view Open House before school starts. On August 22, 4:00-6:00, 6th grade students may pick up their schedules and receive their locker assignments. This is an informal “come and go” event. Parents, please join your student as they become familiar with their classes, learn to work their combinations and meet their teachers!

IMPORTANT INFORMATION Regular school hours are 7:50 a.m. to

3:40 p.m. Students should not arrive before 7:30. Students should be picked up no later than 3:55 p.m. each day.

Teachers can be reached the first week of school. Check our website for email ad-dresses and contact information

http://usd259.org/robinson

Student schedules and locker assign-ments will be distributed on the 1st day of school. Students should report to the following locations after the 7:50 bell: 8th Grade—gym 7th Grade—north end of the cafeteria 6th Grade—office area

There will be no schedule changes the first week of school.

Please bring updated information re-garding immunizations if necessary.

NEWSLETTERS & ENROLLMENT

Future newsletters will be sent electronically, like the previous school year. All newsletters will be available on the school website throughout the school year at http://usd259.org/robinson Enroll-ment documents and forms are also available on this site.

FALL FUNDRAISER On September 2 we will kickoff our all school J.T. Fundraiser. Students will have until September 19 to take orders from their family and friends. The money raised will be used to support classroom needs and student events hosted by PTSO. More details to follow. Thank you for your help!

BLOCK PARTY

All 6th, 7th, and 8th grade students and families are welcome.

When: Tuesday, August 23 Time: 6:00—7:30 p.m. Where: Bleckley Field

There will be music, food, orchestra fundraiser, bas-ketball, volleyball, tetherball, soccer, and oth-er fun activities!

7th & 8th Grade Open House

All 7th and 8th grade students and families are welcome. When: Tuesday, August 23 Time: 5:00—6:30 p.m. Students will get their locker number, locker combination, and class schedule. They can set up their locker at this time.



B ACK T O S CHOOL ED IT I ON 2 0 1 6

Please check the district’s enrollment Web site, www.enroll.usd259.org, during the summer months for the latest in-formation. Online enrollment is scheduled to begin July 15. When enrolling online, please print your receipt if you pay online. Bring the receipt with you to enrollment. You will need to come to school for ID pictures, address verification, and to pick up shirts, lanyards, and other purchased items. August 8—9:00-3:00 August 9—12:00-7:00 August 10—12:00-7:00

New Student? Students new to Wichita Public Schools are required to enroll at their school site.

Please call 973-8600 for information on enrolling a new student at Robinson Middle School.

Proof of current address is required.

Examples of proof of address: rent receipt, lease agreement, gas/electric bill, or mortgage payment stub.

Unsure which school your student will attend? Contact Student Records at 973-4498.

For additional information visit our District Enrollment Site.

Fees and meal payments may be made online at

www.mypaymentsplus.com

Fees Full / Reduced

Textbook Rental $47.00 / $23.50

Agenda/Planner $5.00

Locker Rental $2.00

Student ID $3.00

Explore & Leadership / per semester $10.00

Lanyard for Student ID $5.00

Memory Book $15.00

PE Lock $1.00

PE Uniform $20.00 (Shirt/$8 - Shorts/$12)

Spanish $10.00

P.E. / per semester $5.00

Vocal / Orchestra / Band $10.00

Music Instrument Rental Full—$50.00

Reduced—$25.00 Free—$15.00

Art / per class / per semester $10.00

Incentive Fee $3.00

Robinson T-Shirts (optional) will

be sold at Enrollment for $10.00.

Other Robinson Gear will also be

sold at enrollment.

Get you RAM SPIRIT on!!!

Teachers may require additional funds for specific items during the school year.

http://www.enroll.usd259.org

http://enroll.usd259.org/

BACK TO SCHOOL ED IT ION 2016

You are Invited...

The 6th Grade Sneak Preview

This is a “come and go event” for 6th grade students and their families only.

Date: Monday, August 22

Time: 4:00 p.m.—6:00 p.m.

Where: Robinson Middle School

(Check in at the cafeteria)

Sixth grade students and their families will have the opportunity to meet teachers and explore the build-ing before their first day of school on Tuesday, August 23.

Students will get their locker number, locker combination, and class schedule at Sneak Preview.

Students will also have the opportunity to set up their locker and should bring their supplies to put in their lockers.

Students who are unable to attend the Sneak Preview Open House will receive their schedule during Sixth Grade Orientation on Tuesday, August 23, which is a 1/2 day, ending at 11:30, devoted to helping our 6th graders transition to middle school.


Set your

Child on the

Path of

Success!

7th & 8th Grade

Students & Families 7th & 8th grade students and their families will have the

opportunity to meet teachers, set up their locker, and explore the

building before their first day of school on

Wednesday, August 24.

Tuesday,

August 23

5:00-6:30

Students will get their locker number, locker combination, and class schedule.

Students who are unable to attend the Open House will receive their schedule

the following day, Wednesday, August 24.


ALL Robinson students, families, and community mem-

bers are invited to attend our Back 2 School Block Party

When: Tuesday, August 23

Time: 6:00—7:30 p.m.

Where: Bleckley Field

Who: All 6th, 7th, & 8th Grade Students & Families

Music

Food

Orchestra BBQ

Basketball

Fun & Activities

Soccer

Tetherball

Buy Spirit Gear

Volleyball


First Day for 6th Grade

Students

Tuesday, August 23

8:00 to 11:30

Meet in the Auditorium!

Buses will be running!

First Day of School

For ALL Students

Wednesday, August 24

8:00 to 3:40

Buses will be running!

Don’t be late!

Attention All Incoming 7th and 8th Grade Students! Cross country is around the corner!!. Interested in getting a bit more information? There will be a Coach/Parent/Athlete meeting on Tuesday, August 2nd at 5:30 PM in the cafeteria and it is important that all students that are planning, or even considering participating in cross country, attend with a parent. Before any student-athlete will be allowed to participate with the team they must have the following paperwork filed with the office:

A KSHSAA physical completed after May 1st, 2016 and the green concussion form; availa-ble online and in the main office

An insurance form (blue); available online and in the main office A Running Off Campus permission slip; available online A Runner’s Contract; available online And have earned a 2.25 GPA or higher in the Spring semester

and passing at least 5 subjects

Student-athletes should be able to run two miles without stop-ping before the first day of practice, so find a friend, lace up your shoes, and start training for a great cross country season with us this fall!

Any questions may be directed to Coach Marsh at [email protected] or Coach Kratz at [email protected].

mailto:[email protected]



Summer 2016 Update

Robinson Foundation for Education Excellence

In May, the board allocated funds towards the following request in the school. Two licenses for SMART Notebook Math Tools

add-on software to be used in 6th grade math classes. The tools integrate with the software currently being used in the class-

room and the tools expand the functionality of the SMART notebook software .

The Foundation Board for the 2016-2017 School year are:

Patresa Ebersole, President

Amy Champlin, Vice President

Suzanne Laycock, Secretary

Gautham Reddy, Treasurer

Jennifer Halabi

Janet Jump

Lisa McPherson

Tina Morris

Lynette Murphy

Denah Rusk

Kirk Seminoff

To be voted for approval in at the first board meeting of the year:

Boualem Goual Belhamidi and Nabila Cherehem, Linda Salazar

As we look towards the 2016-2017 school year, We invite you to consider joining the board. Come to the meeting in

May to learn more about us. The current board is seeking several volunteers to be responsible for a few of our ongoing efforts to

raise money for our school. The Foundation works as a board, plans special events and raises funds to provide educational en-

hancement grants to Robinson teachers for equipment, books, or other materials that are not provided for in traditional budg-

ets. Each month we have a meeting to conduct business. All parents are welcome to attend our meetings! Being a part of the

board gives you an opportunity to meet other Robinson parents, learn more about our school and give support to our teachers

and staff.

We rely on the dedication of our board members to help the foundation be successful at the school. If you have an in-

terest in serving, you would become a member of the board and then fill one of the following roles.

Restaurant Night Coordinator-This individual maintains our current restaurant nights with Il Vicino, Chipotle and Dairy

Queen. However we have quite a few other restaurants that would like us to have restaurant nights. Coordination of current

and future restaurant nights throughout the year will be done with this role.

Concession Stand Coordinator-For two years now, the foundation has sponsored the concession stand at home games. There

are about 2 home volleyball games, 6 basketball and 2 track events that we sell concessions at. The coordinator would be re-

sponsible for organizing the concession stand volunteers and maintaining the stock of concessions and setting up/taking down

concessions.

Pancake Night Coordinator-This individual organizes two meal events a year. The one in the fall usually coincides with a vol-

leyball game and the one in the spring coincides with the Pre-IB projects night. The coordinator arranges promotion, the meal,

and volunteers for each night.

If you have a desire to serve on the Foundation Board, contact: Patresa Ebersole at [email protected]. Board meeting

dates for the upcoming school year will be set in the summer.

THANKS TO THESE FAMILIES who have donated to Foundation for the 2015-2016 school year: The parents of Clay Becker,

Jeffrey & Patricia Blessant, The parents of Annika Bubp, The parents of Cameron Connolly, Son Anh Dao and Thom T Nguyen,

Lowell & Patresa Ebersole, Adam & Jennifer Halabi, Akash Joshi & Arti Gupta, The parents of Angel Jump, The parents of

Sydney Knott, The parents of Eloise Lavacek, Lori LoNigro, Ravindra Kiragi and Nandini Chandrawadi Mark & Suzanne Lay-

cock, Phouc Q. Lee and Chaiw-Weai Loo, Marsha Meyersick, The parents of Zoe Moser, John and Doreen Papadatos, Tamara

Patterson, The parents of Eric Pham, The parents of Declan Peters, Kirk & Kim Seminoff, The parents of Veronica Spillman,

Christopher & Leasa Wilch, Eric & Paula Zoller

THANKS TO THESE MATCHING GIFT COMPANIES who have donated to the Foundation this school year: Wells Fargo

THANK YOU Chipotle, Dairy Queen, & Il Vicino for your support!

Help us continue to provide for these needs and more at our school in the upcoming school year! Donations will be accepted at

enrollment. You can support the Robinson Foundation on MyPaymentsPlus or by sending a check made out to Robinson Foun-

dation to our school at 328 N. Oliver, Wichita KS 67208. Check our page under Parent Information on the Robinson website for

more info.


August 31.

Due to Math Teacher by August 31, 2016

August 26.


7th/8th Grade Athletics

Those 7th and 8th grade students wishing to participate in ath-letics must have a physical examination and Concussion form com-pleted and signed by parents and a physician before trying out for any sport. Physical forms and Concussion forms can be picked up at enrollment or in the school office throughout the year. Our first competitive sport this year will be Cross Country.

CAFETERIA INFORMATION

The cafeteria staff is available from 8:15-2:00 each day. In order to contact the cafeteria staff you may call 973-8609. Prices for meals are as follows:

Full Pay—Breakfast ($1.35) Lunch ($2.30)

Reduced Pay—Breakfast ($.30) Lunch ($.40)

The cafeteria accepts only cash or checks. Debit and Credit cards can be used online at

www.MyPaymentsPlus.com or by phone at 1-866-736-9007. You will need the student’s name and 6 digit I.D. Once paid, it can take up to 24 hours for payments to show in the student’s account at school.

PTSO – SUMMER 2016 PTSO will try to fill in the gaps this summer

For the second straight year, Robinson’s operating budget has been cut by 10 percent. PTSO is sponsoring a supply drive that we hope fills in some of the holes that a crunch like that creates. We’re encouraging parents and students to bring any of the following items to Robinson during enrollment. For each item donated, a student puts his/her name into a drawing for gift cards from local merchants. Here are the items teachers run out of quickly. Donating any of these at enroll-ment puts your name into the drawing:

Plain white copier paper (ream)

Box of pencils

3-inch binder

Pencil pouch

Package of loose-leaf paper (college ruled) Thank you in advance for your help! We’ll have a PTSO meeting this summer – don’t know when yet With the district and school calendar not completed because of the budget crunch, we don’t yet have a date for a summer PTSO meeting. But we will have one, likely at 1 p.m. on a weekday in the cafeteria. Please check our Face-book page (search for “Robinson PTSO”) and we’ll also try to update via Parentlink. Student directory coming this fall PTSO will produce this fall a digital version of a Robinson student directory. We feel a directory is useful given that so many of our students come from a variety of elementary schools. Inclusion in the directory is optional. Paperwork for the directory will be included in the summer enrollment packet mailed to your home. You can also sign up at enrollment. Once completed, the directory will be available to parents and staff and not posted anywhere online by PTSO.

http://www.MyPaymentsPlus.com


AUTHORIZATION FOR MEDICATION/PROCEDURE TO BE ADMINISTERED AT SCHOOL & FIELD TRIPS

Part A - Parent to Complete

Name of Student: Date of Birth: Grade/Teacher:

I grant permission for the school nurse or a delegated staff member to administer medication/treatment to my child at school or on a field trip as indicated by my child’s health care provider as described in Part B listed below.

I understand I must provide all 1. medication in its original labeled container and/or 2. necessary supplies

I also give permission for communication between the school health professional and the medical prescriber and dispensing pharmacy related to the specific medication/treatment in question, including communication concerning:

1. the prescription or treatment itself – i.e., questions regarding dosage, method of administration, and potential drug interactions.

2. implementation of the treatment in school – i.e., questions regarding safety concerns, infection control issues, or modifications in the treatment order related to the school setting or student's academic schedule.

3. student outcomes from the treatment – i.e., questions regarding observed side effects, possible negative reactions, observations of behavior changes in the classroom.

4. other pertinent issues related to the student’s diagnosis, condition, or treatment.

__ Parent /Legal Guardian Signature Printed Name of Parent /Legal Guardian Today’s Date

_____ _ __ Home Phone Cell Phone Work Phone

__ Parent Designee Name Parent Designee Cell Phone Parent Designee Work Phone

Part B - Health Care Provider to Complete

MEDICATION AND/OR TREATMENT ORDERS: (please specify)

Medication / Treatment Dosage / Route Time / Frequency Diagnosis(es) / Indication

Special Instructions:

Signature of Physician/APRN/PA Printed Name of Physician/APRN/PA Name of the Supervising Physician for APRN/PA

Health Care Provider Phone Number Health Care Provider FAX Number Today’s Date

This student has demonstrated the skill level necessary to self-administer such medication/treatment.

Yes Signature of Physician/APRN/PA Medication(s)/Treatment(s) that can be self-administered

School Fax

316-973-

School Year

20 - 20


WICHITA PUBLIC SCHOOLS Division of Student Support Services

DEPARTMENT OF HEALTH SERVICES

GUIDELINES FOR MEDICATION & PROCEDURES - Prescribed Special Health Care Services (PSHCS)

Refer to BOE Policy 5316 & 5317 ~Revised September 22, 2015

Medication & Procedure/PSHCS requests must be renewed each school year

Procedures/PSHCS are services

prescribed by a health care provider that require specialized training to implement. that are necessary to enable the student to attend school and/or programs occurring before/after

school and hosted or controlled by the school. Examples of Procedures/PSHCS include injections such as insulin and emergency auto injectors.

The Licensed Registered Professional School Nurse

Regarding non-prescription and prescription medication

1. must review all medication requests prior to initiating their administration.

2. may designate and train non-nurse school employee(s) to administer medication. a. If at all possible, medications should be taken prior to coming to school or after leaving school

under parental supervision.

Regarding Procedures/PSHCS

1. is responsible to review and process the request for the Procedure/PSHCS.

2. is involved in the planning and provision of the services. a. The result of this planning will result in the student’s own Emergency Medical Plan - EMP.

3. may designate and train non-nurse school employee(s) to perform Procedure/PSHCS.

The Parent/Legal Guardian –

1. must provide a new Authorization for Medication/Procedure at School each school year. a. The signature of the parent/legal guardian and completion of the Authorization for

Medication/Procedure at School authorizes an exchange of information with the school and health care provider/agency.

Regarding non- prescription and prescription medication

1. must notify the school immediately regarding changes. Any changes in dosage or schedule require a

a. new written request from the health care provider b. correctly labeled medication container

2. will contact the nurse prior to the end of the year to discuss arrangements for transfer of medication.

Regarding Procedure/PSHCS

1. must notify the school immediately regarding changes. a. Changes require a new written request from the health care provider and approval of the nurse.

2. is responsible for providing, maintaining, servicing and replacing necessary equipment and supplies– i.e., syringes, tubing, glucose tabs, etc.

a. Equipment must be correctly labeled with directions for use.

3. will contact the nurse prior to the end of the year to discuss arrangements for transfer of equipment.


Come JOIN our Legacy of Excellence! Robinson Middle School has a rich, vibrant history in Wichita and we welcome all fam-ilies, guardians and students to join in that legacy. Opening our doors over 80 years ago you can walk the halls and classrooms where some of your grandparents – even great grandparents once studied. Now you, the promotion classes and families of 2017, 2018 and 2019 will be able to watch our building grow in the 21st century with our additions of a FEMA shelter and state of the art auditorium. We hope that incoming 6th grade parents will volunteer to help with our 6th Grade Mixer which is scheduled in the first weeks of the school year. It is a fun party, for 6th graders only, to get to know each other and participate in Robinson traditions. Con-tact our volunteer coordinator [email protected] or Mr. Kirk Seminoff [email protected] for further information and to let us know you would like to help. All families can participate in our two parent organizations. Our PTSO supports our school by organizing our many social activities for staff and students – Back to school Block Party, 6th Grade Mixer, Dance DJ Parties, 8th Grade Promotion Ceremony and Party, Teacher/Staff appreciation etc. Other PTSO initiatives are to fundraise and sup-port student needs and events such as the 25 book campaign awards, state testing bingo party and other occasions. Robinson Middle School also has a 501(c)3 Foundation which was formed over 20 years ago to help disseminate various donations to educational needs at Robinson. You and perhaps your company can make a difference by making a tax deductible do-nation to the Robinson Foundation for Educational Excellence. Please contact Patrese Ebersole at [email protected] for further information.

Always check our website http://usd259.org/robinson on the “Parent Links” pages – for published information about both our PTSO and our Foundation. Robinson also supports community organizations like Big Brothers/Big Sisters, Communities in Schools and others and we strongly encourage parents to consider volunteer service to their school. Contact our volunteer coordinator [email protected] for further information. We look forward to seeing you at enrollment!







6th Grade Supply List

Students keep and carry these supplies DAILY in binder:

(1) 3” Binder (3) Packages of loose-leaf notebook paper

(college or wide rule) Set of Tab Dividers (1) Pencil Bag (need to be 3-hole punched

for binder) Pencils or Mechanical Pencils- need lead (1) Package of Black or Blue Ink Pens (1) Package of EXPO Dry Erase Markers (1) Small Pencil Sharpener (1) Big Eraser or 1 package of small erasers

for top of pencils (1- 2) Highlighters (1) Package of Colored Pencils

Students give to your 1st hour 6th Grade Teacher: For class use or if in ( )…give to specific teacher

(2) Composition Books (give to your Math &

Language Arts Teacher) (1) Box of Crayons (1) Package of Red Ink Pens (give to your

Math Teacher) (1) Package of Crayola Markers (no Sharpies

or Permanent Markers) (1) Package of BLACK expo Dry Erase Mark-

ers (give to your Math or Language Arts Teacher) (1) Ream of White Paper (1-3) Boxes of Kleenex (1) Roll of Paper Towel (1) Disinfectant Wipe Bottle (1) Hand-sanitizer Bottle

Applied Academics Supply List

Pencils Scissors Ruler Erasers Backpack 4 Glue Sticks 1 Roll of Scotch Tape 2 Rolls of Paper Rolls 1 box of sandwich bags Crayons or Colored Pencils Calculator (large key if possible) 3 boxes of Tissues (plain, no lotion or scents) 2 containers of Wet-Ones (preferably unscented) 1 Pack of Expo Dry Erase Markers (chisel tip, any

color) 2 bottles (with pump) of Hand Sanitizer (preferably

unscented) Lock with 2 Keys* (see note below) Agenda** (see note below)

Additional supplies will be needed throughout the school year for cooking and other life skills activities. Notes will be sent home at the time items are needed.

*Lock with 2 keys is for hallway locker. Medium size works best. The 2nd key will be kept with teacher as a back-up in case students loses 1st key.

**ALL students will need to purchase an agenda at en-rollment. We use these everyday as a communication tool between home and school so it’s very important that each student have one**

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjCl5HjgJnNAhUiGFIKHczMCw8QjRwIBw&url=http%3A%2F%2Fwellsbranchpta.org%2F2016%2F05%2F03%2Fschool-supplies-for-next-year%2F&psig=AFQjCNEniib7S4njO_W6CGI3qnAri-4



SCHOOLWIDE BINDERS EVERY student at Robinson Middle School will be learning strategies to help build organization. Below are the materials needed for the Robinson Binder: 3-inch, 3-ring binder (no smaller than 3 inches)

Please do not purchase zipper binders—they do not have 3-inch rings 1 set of tabbed dividers 3-ring pencil pouch Several packages of College-ruled loose-leaf paper* Several packages of pencils* Large erasers Blue and black pens One package of thin highlighters One package of thin dry erase markers *these supplies frequently need to be replenished during the school year; it might be helpful to purchase extras to store until they are needed

7th grade supplies Personal pencil sharpener for pencil pouch One package of colored pencils 4 One-subject college-ruled spiral notebooks 2 two-pocket folders TI-30XS Multiview Scientific Calculator (please put your name on it) * see ordering information to purchase through the school at a discount

Classroom Supplies: please give to your third hour teacher at open house

3-pack of tissues 3-pack of disinfectant wipes 1 package of paper towels 1 package of dry erase markers On occasion, teachers may have specific requests for classroom supplies. Teachers will inform your student of these additional needs.

CALCULATOR INFORMATION In order to be prepared for state assessments, we are asking that students all have the same calculator that is available on the state assessments….the TI-30XS Multiview! We can order these for each student at a discounted rate of $13.00. We will do a onetime order on August 31. Students will need to turn in $13.00 to their math teacher by August 26.

If you purchase a new Texas Instruments Calculator please look for the TI Technology Rewards symbol. Please cut out the label and return to Ms. Van Horn in Room 217. These points will help our school earn FREE Texas Instrument materials to use in our classrooms!



For Personal Use (Students keep and carry with them daily):

(1) 3” Binder (3) Packages College – Ruled Notebook Paper (1) Set of 5 Dividers, with Pockets (2) 2-Pocket Folders (with prongs) (1) Pencil Bag that is 3-hole punched (for Binder) Pencils and more Pencils (plus Lead for Mechanical Pencils) (1) Pkg. Black/Blue Ink Pens (1) Pkg. RED grading pens (1) Small Pencil Sharpener (2) Big Erasers (1) Pkg. Multicolored Highlighters (1) Set of Colored Pencils

Johnson (Math)

(1) “Five Star” 3 or 5 subject spiral College Rule OR (3) Single subject College Rule spirals West (Math)

(1) Graph Composition Book Basler (Science)

“Five Star” 3 or 5 subject spiral (1) package of college ruled paper

Social Studies

“Five Star” 3 or 5 subject spiral Language Arts

(3) single subject spiral notebooks For Classroom Use (Give to 1st hour teacher):

(1) Pkg. glue sticks (1) Pkg. EXPO Dry Erase Markers (1) Roll of Paper Towels (3) Large Boxes of Kleenex (1) Pkg. Clorox/Disinfectant Wipes (1) Bottle of Hand Sanitizer


7/8TH GRADE BANDS Supply List

7th Grade Band “Essential Elements 2000” Book 1 (should already own) ”Essential Elements 200” Book 2 “Foundations for a Superior Performance” All cleaning supplies needed for specific instrument Box of tissue

8th Grade Band “Essential Elements 2000” Book 2 (should already own) “Essential Elements 2000” Book 3 “Foundations for a Superior Performance” (should already own) All cleaning supplies needed for specific instrument A ream of colored paper Lyre and flip folder (no lyres needed for French Horns, Baritones, Tubas or Percussion. Percussionists do not need

flip folders.

Orchestra Supply List 6th Grade

Instrument (rentals available through the school when class starts)

Strictly Strings books I & 2 Rosin for their instrument (Bass needs Pops ros-

in) Rock stop for cello & bass students Violin & viola students need a shoulder pad Black three ring binder Torte mute (different for each instrument) Pencil and highlighters Box of Kleenex Package of colored copy paper (your choice)

7th & 8th Grade

Violin students have their own instrument Viola, cello & bass students may rent from the

school Black three ring binder Pencil & highlighters Torte mute

Choir Supply List

7th Grade Choir 1 box of tissues 1 bottle of hand sanitizer 1 black 2 pocket folder 1 box #2 pencils

(Ticonderoga is awesome, but any brand is fine!)

8th Grade Choir 1 box of tissues 1 bottle of hand sanitizer 1 purple 2 pocket folder 1 box #2 pencils (Ticonderoga is awesome, but any

brand is fine!)

6th grade Music/Fine Arts 1 box of tissues 1 bottle of hand sanitizer 1 1-inch 3 ring binder, any color or design 1 box #2 pencils (Ticonderoga is awesome, but any

brand is fine!)

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwj9sZKVipnNAhUWU1IKHW4MA_IQjRwIBw&url=http%3A%2F%2Fwww.mansfieldct.gov%2Fcontent%2F11169%2F11181%2F11298%2F12363%2F26294%2Fdefault.aspx&bvm=bv.124088155,d.aXo


6th Pre-IB Supply List Required Supplies Zip Closed Binder (3”) with the following inside for Language Arts, Math, Social Studies, and Spanish:

16 Tabbed Set of Dividers (2 sets of 8) Loose Leaf Paper (NOT spirals; place inside binder)** Protractor Ruler

Pencil Case with the following inside to be carried to all classes: Pens (Blue, Black, and Red)** Highlighters** Ticonderoga Pencils and more Pencils (plus lead for mechanical pencils)** Pencil Top Eraser or Large Eraser** Dry Erase Markers (thin sized)** Colored Pencils ** Flash Drive--Please put your name on it (any size) TI-30XS Multiview Scientific Calculator(please put your name on it) (See Order Form).

1 Subject Spiral Notebook (100 pages, at least one pocket folder inside, plastic cover needed to last the year, for science; students keep it to carry to class)

3 spiral notebook-1 subject (must be metal bound) 2 packages of Index Cards for Spanish (Optional) standard sized locker shelf Classroom Supplies (Please give to Ms. Berry) 2 boxes of Kleenex 4 rolls of scotch tape 6 glue sticks 2 packages of Index Cards** 1 package of Scrapbook paper (at least 50 sheets) 2 packages of Ticonderoga Pencils 1 ream of white paper 1 package of ¼ inch Graph Paper 1 package post-it notes(any size, color or number) **These supplies frequently need to be replenished during the school year. On occasion, teachers may have specific requests for classroom supplies. Language Arts and Spanish teachers will be asking for a couple of novels to be purchased throughout the year. If you purchase a new Texas Instruments Calculator please look for the TI Technology Re-wards symbol. Please cut out the label and return to Ms. Van Horn in Room 217. These points will help our school earn FREE Texas Instrument materials to use in our classrooms!


Required Supplies 5 One Inch 3 Ring Binder (one for each

class: Language Arts, Math, Science, So-cial Studies, and Spanish) with the follow-ing inside:

Loose Leaf Paper (NOT spirals; place inside binder)**

Graph Paper (In math and Science binder only)

8 dividers

Zip Closed Binder (3”) with the following in-side for Language Arts, Math, Science, Social Studies, and Spanish:

16 Tabbed Set of Dividers (2 sets of 8) Loose Leaf Paper (NOT spirals; place

inside binder)** Graph Paper

OR

7th and 8th Grade Pre-IB Supply List

Pencil Case with the following inside to be carried to all classes: Pens (Blue, Black, and Red)** Gel or Non-Smear Highlighters** Pencils and more Pencils (plus lead for mechanical pencils)** Large Eraser** Dry Erase Markers (thin sized)** Markers —or— Colored Pencils —or— Crayons** Flash Drive--Please put your name on it (any size) 1 package of Assorted Color Flags TI-30XS Multiview Scientific Calculator(please put your name on it) (See Order Form).

3 packages of Index Cards Sheet Protectors—at least 50 ALL Language Arts: (2nd Semester) Preferred editions: Dover, No Fear Shakespeare or Shakespeare

Made Easy. 7th Grade: A Midsummer Night’s Dream by William Shakespeare 8th Grade: Much Ado About Nothing by William Shakespeare

Gifted Language Arts Only: 2 Composition Notebooks (Optional for Math 8 Plus—Van Horn) TI-84 PlusCE Graphing Calculator (please put your name on it). Classroom Supplies (Please give to 6th Hour Teacher) AAA Batteries (Please give to Math Teacher) 2 boxes of Kleenex 1 package (4 pack) Dry Erase Markers Optional

Paper Towels Hand Sanitizer Anti-Bacterial Wipes

**These supplies frequently need to be replenished during the school year. On occasion, teachers may have specific requests for classroom supplies. Language Arts and Spanish teachers will be asking for a couple of novels to be purchased throughout the year. If you purchase a new Texas Instruments Calculator please look for the TI Technology Re-wards symbol. Please cut out the label and return to Ms. Van Horn in Room 217. These points will help our school earn FREE Texas Instrument materials to use in our classrooms!


DRESS CODE POLICY

Appropriate student behavior/dress is necessary to provide a quality learning environment at Robin-

son. The vast majority of students ARE appropriately dressed and their efforts in this regard ARE ap-

preciated.

Please remember:

1. The decision of the building administration will be final in all disputes concerning student dress.

2. Students will be expected to show their Student Identification card to every 1st hour teacher upon

entering the classroom. If students do not have an ID, then they will be sent to the office to get a

temporary ID. ID’s should be on the student’s body at all times throughout the school day. After 3

infractions of not having a student ID, students will serve a detention. After that, students will

serve a detention for every infraction. Student ID’s may not have stickers, markers, or anything

covering up the students pictures or barcode.

3. Cell phones and electronic devices and accessories are to be kept powered off, out of sight, and not

used during the school day. Cell phones and electronic devices are not allowed to be visibly carried

during the school day from 8:00—3:40.

4. Clothing or items that advertise or promote gang affiliation, drugs, alcohol or tobacco products, con-

tain references to sex, profanity, or show suggestive, vulgar, obscene writing, pictures or symbols

are not allowed. (items referring to specific body parts)

5. ALL shirts must have sleeves. Spaghetti strap tees or tank top undershirts are not allowed even if

worn under a jacket. Shirttails must be long enough (3” overlap with pants) to cover midriff, skin

and under clothing while sitting or standing. Shirts must not show the chest area, stomach, and

back.

6. Shorts, sports shorts, and skirts must be finger-tip length or longer in the front, in the back, and on

the sides, when walking, even when worn with leggings. Shorts with the slits in the sides are not

allowed.

7. Hats, hoods, caps should be worn outside only and should be kept in your locker during the school

day. Bandanas, do-rags, and sweatbands are not allowed.

8. Sunglasses, chains, dog collars, and attire are prohibited.

9. Students are not allowed to wear hoodies or hats inside the building.

10. Underwear, pajamas, or house slippers should not be worn to school as clothing.

11. Pants, jeans, skirts, and shorts should fit correctly at the waist and not expose any under clothing.

Sagging is not permitted. Students sagging will have ‘ties’ put into the belt loops to hold the pants

up appropriately. Students who continue to sag their pants will be written up and referred to ad-

ministration for additional consequences.

12. Ripped or torn pants that show skin above fingertip length should have leggings underneath.

13. No clothing or item that gives the impression of any gang affiliation will be permitted.

14. Excessive make-up and hairstyles are not permitted if they are a distraction to learning.

15. Spandex leggings (jeggings) should not be worn unless underneath shorts, skirts, or pants of finger-

tip length.

16. Coats, purses, and book bags must be kept in the locker during the day.

The above code/expectations will be applied fairly and equally regardless of gender. Changes or addi-

tions to the Dress Code may be made based on the need to maintain a proper learning environment

during the year. If a student is dressed inappropriately, the student will be given three choices: 1)

Change clothing, 2) go to ISSR, or 3) call a parent/guardian to bring appropriate clothing. Repeated

offenses will be considered insubordination and addressed accordingly. The decision of the building ad-

ministration will be final in all disputes concerning student dress. Consequences are the following, but

not limited to a phone call home, detention, after school detention, in-school suspension, out of school

suspension.

http://www.google.com/url?sa=i&rct=j&q=i+love+boobies+logo&source=images&cd=&cad=rja&docid=0OPQJmcy0Ui3vM&tbnid=jhj9ZSwFX5wB5M:&ved=0CAUQjRw&url=http%3A%2F%2Fjustsnowboard.blogspot.com%2F2010%2F11%2Fjust-snowboard-camps-mint-snowboarding.html&ei=3bmCUcy3


HISTORY FORM (should be filled out by the student and parent/guardian prior to the physical examination)

Name Sex Age Date of birth

Grade School Sport(s) Home Address Phone -

Personal physician Parent Email PPE is required annually and shall not be taken earlier than May 1 preceding the school year for which it is applicable.

Explain “Yes” answers below. Circle questions you don’t know the answers to.

I hereby state that, to the best of my knowledge, my answers to the above questions are complete and correct.

Signature of athlete Signature of parent/guardian Date

© 2010 American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports

Medicine. Permission is granted to reprint for noncommercial, educational purposes with acknowledgment. Rev. 1/15

Medical Questions Yes No

27. Do you cough, wheeze, or have difficulty breathing during or after exercise?

28. Have you ever used an inhaler or taken asthma medicine? 29. Is there anyone in your family who has asthma? 30. Were you born without or are you missing a kidney, an eye, a testicle

(males), your spleen, or any other organ?

31. Do you have groin pain or a painful bulge or hernia in the groin area? 32. Have you had infectious mononucleosis (mono) within the last month? 33. Do you have any rashes, pressure sores, or other skin problems? 34. Have you had a herpes or MRSA skin infection? 35. Have you ever had a head injury or concussion?

If yes, how many? What is the longest you've been held out of sports or school? When were you last released?

36. Have you ever had a hit or blow to the head that caused confusion, prolonged headache, or memory problems?

37. Do you have a history of seizure disorder? 38. Do you have headaches with exercise? 39. Have you ever had numbness, tingling, or weakness in your arms or

legs after being hit or falling (Stinger/Burner/Pinched Nerve)?

40. Have you ever been unable to move your arms or legs after being hit or falling?

41. Have you ever become ill while exercising in the heat? 42. Do you get frequent muscle cramps when exercising? 43. Do you or someone in your family have sickle cell trait or disease? 44. Have you had any problems with your eyes or vision? 45. Have you had any eye injuries? 46. Do you wear glasses or contact lenses? 47. Do you wear protective eyewear, such as goggles or a face shield? 48. Do you worry about your weight? 49. Are you trying to or has anyone recommended that you gain or lose

weight?

50. Are you on a special diet or do you avoid certain types of foods? 51. Have you ever had an eating disorder? 52. Do you have any concerns that you would like to discuss with a doctor? Females Only Yes No

53. Have you ever had a menstrual period? 54. If yes, are you experiencing any problems or changes with athletic

participation (i.e., irregularity, pain, etc.)?

55. How old were you when you had your first menstrual period? 56. How many periods have you had in the last 12 months?

Explain “yes” answers here

General Questions Yes No

1. Have you had a medical condition or injury since your last check up or sports physical?

2. Has a doctor ever denied or restricted your participation in sports for any reason?

3. Do you have any ongoing medical conditions? If so, please identify below:

Asthma Anemia Diabetes Infections Other:

4. Have you ever spent the night in the hospital? 5. Have you ever had surgery?

Heart Health Questions About You Yes No

6. Have you ever passed out or nearly passed out DURING or AFTER exercise?

7. Have you ever had discomfort, pain, tightness, or pressure in your chest during exercise?

8. Does your heart ever race or skip beats (irregular beats) during exercise?

9. Has a doctor ever told you that you have any heart problems? If so, check all that apply:

High blood pressure A heart murmur High cholesterol A heart infection Kawasaki disease Other:

10. Has a doctor ever ordered a test for your heart? (For example, ECG/ EKG, echocardiogram)

11. Do you get lightheaded or feel more short of breath than expected during exercise?

12. Have you ever had an unexplained seizure? 13. Do you get more tired or short of breath more quickly than your friends

during exercise?

Heart Health Questions About Your Family Yes No

14. Has any family member or relative died of heart problems or had an unexpected or unexplained sudden death before age 50 (including drowning, unexplained car accident, or sudden infant death syndrome)?

15. Does anyone in your family have hypertrophic cardiomyopathy, Marfan syndrome, arrhythmogenic right ventricular cardiomyopathy, long QT syndrome, short QT syndrome, Brugada syndrome, or catecholaminer- gic polymorphic ventricular tachycardia?

16. Does anyone in your family have a heart problem, pacemaker, or implanted defibrillator?

17. Has anyone in your family had unexplained fainting, unexplained seizures, or near drowning?

Bone And Joint Questions Yes No

18. Have you ever had an injury to a bone, muscle, ligament, or tendon that caused you to miss a practice or a game?

19. Have you ever had any broken or fractured bones or dislocated joints? 20. Have you ever had an injury that required x-rays, MRI, CT scan, injec-

tions, therapy, a brace, a cast, or crutches?

21. Have you ever had a stress fracture? 22. Have you ever been told that you have or have you had an x-ray for neck

instability or atlantoaxial instability? (Down syndrome or dwarfism)

23. Do you regularly use a brace, orthotics, or other assistive device? 24. Do you have a bone, muscle, or joint injury that bothers you? 25. Do any of your joints become painful, swollen, feel warm, or look red? 26. Do you have any history of juvenile arthritis or connective tissue

disease?

Pre-Participation Physical Evaluation Kansas State High School Activities Association • 601 SW Commerce Place • PO Box 495 • Topeka, KS 66601 • 785-273-5329

PPE

Medicines and Allergies: Please list all of the prescription and over-the-counter medicines, inhalers, and supplements (herbal and nutritional) that you are

currently taking:

No Medications

Do you have any allergies? Yes No If yes, please identify specific allergy below.

Medicines Pollens Food Stinging Insects

What was the reaction?


PHYSICAL EXAMINATION FORM

Name: Date of birth: Date of recent

immunizations: Td Tdap Hep B Varicella HPV Meningococcal

PHYSICIAN REMINDERS

1. Consider additional questions on more sensitive issues

• Do you feel stressed out or under a lot of pressure? • Do you ever feel sad, hopeless, depressed, or anxious? • Do you feel safe at your home or residence? • Have you ever tried cigarettes, chewing tobacco, snuff, or dip? • During the past 30 days, did you use chewing tobacco, snuff, or dip?

• Do you drink alcohol or use any other drugs?

• Have you ever taken anabolic steroids or used any other performance supplement?

• Have you ever taken any supplements to help you gain or lose weight or improve your performance?

• Do you wear a seat belt and use a helmet?

2. Consider reviewing questions on cardiovascular symptoms (questions 5–14).

EXAMINATION

Height Weight Male Female | BP (reference gender/height/age chart)**** / ( / ) Pulse

Vision R 20/ L 20/ Corrected: Yes No MEDICAL NORMAL ABNORMAL FINDINGS

Appearance • Marfan stigmata (kyphoscoliosis, high-arched palate, pectus excavatum, arachnodactyly, arm span > height, hyperlaxity, myopia, MVP, aortic insufficiency)

Eyes/ears/nose/throat • Pupils equal • Gross Hearing

Lymph nodes Heart *

• Murmurs (auscultation standing, supine, +/- Valsalva) • Location of point of maximal impulse (PMI)

Pulses • Simultaneous femoral and radial pulses

Lungs Abdomen Genitourinary (males only)** Skin

• HSV, lesions suggestive of MRSA, tinea corporis

Neurologic*** MUSCULOSKELETAL Neck Back Shoulder/arm Elbow/forearm Wrist/hand/fingers Hip/thigh Knee Leg/ankle Foot/toes Functional

• Duck-walk, single leg hop

*Consider ECG, echocardiogram, and referral to cardiology for abnormal cardiac history or exam. **Consider GU exam if in private setting. Having third party present is recommended.

***Consider cognitive evaluation or baseline neuropsychiatric testing if a history of significant concussion.

****Chart found in: The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents. Pediatric BP mobile application can also be used.

Cleared for all sports without restriction

Cleared for all sports without restriction with recommendations for further evaluation or treatment for

Not cleared

Pending further evaluation

For any sports

For certain sports

*Reason

Recommendations

I have examined the above-named student and student history and completed the preparticipation physical evaluation. The athlete does not present apparent clinical contraindications to practice and participate in the sport(s) as outlined above. If conditions arise after the athlete has been cleared for participation, the physician may rescind the clearance until the problem is resolved and the potential consequences are completely explained to the athlete (and parents/ guardians).

Name of healthcare provider (print/type) Date

Address Phone

Signature of healthcare provider , MD, DO, DC, PA-C, APRN (please circle one)

©2010 American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports

Medicine. Permission is granted to reprint for noncommercial, educational purposes with acknowledgment. Rev. 1/15

Pre-Participation Physical Evaluation Kansas State High School Activities Association • 601 SW Commerce Place • PO Box 495 • Topeka, KS 66601 • 785-273-5329

PPE


Rev. 1/15

ATTENTION PARENTS AND STUDENTS

KSHSAA ELIGIBILITY CHECK LIST

NOTE: Transfer Rule 18 states in part, a student is eligible transfer-wise if:

BEGINNING SEVENTH GRADER—A seventh grader, at the beginning of his or her seventh grade year, is eligible under the Transfer Rule at any school he or she may choose to attend. In addition, age and academic eligibility requirements must also be met.

BEGINNING NINTH GRADERS IN A THREE-YEAR JUNIOR HIGH SCHOOL—So that ninth graders of a three-year junior high are treated equally to ninth graders of a four-year senior high school, a student who has successfully completed the eighth grade of a two-year junior high/middle school, may transfer to the ninth grade of a three-year junior high school at the beginning of the school year and be eligible immediately under the Transfer Rule. Such a ninth grader must then as a tenth grader, attend the feeder senior high school of their school system. Should they attend a different school as a tenth grader, they would be ineligible for eighteen weeks.

ENTERING HIGH SCHOOL FOR THE FIRST TIME—A senior high school student is eligible under the Transfer Rule at any senior high school he or she may choose to attend when senior high is entered for the first time at the beginning of the school year. In addition, age and academic eligibility requirements must also be met.

For Middle/Junior High and Senior High School Students to Retain Eligibility

Schools may have stricter rules than those pertaining to the questions above or listed below. Contact the principal or coach on any matter of eligibility. A student to be eligible to participate in interscholastic activities must be certified by the school principal as meeting all eligibility standards.

All KSHSAA rules and regulations are published in the official KSHSAA Handbook which is distributed annually and is available at your school principal’s office.

Rule 7 Physical Evaluation - Parental Consent—Students shall have passed the attached evaluation and have the written consent of their parents or legal guardian.

Rule 14 Bona Fide Student—Eligible students shall be a bona fide undergraduate member of his/her school in good standing.

Rule 15 Enrollment/Attendance—Students must be regularly enrolled and in attendance not later than Monday of the fourth week of the semester in which they participate.

Rule 16 Semester Requirements—A student shall not have more than two semesters of possible eligibility in grade seven and two semesters in grade eight. A student shall not have more than eight semesters of possible eligibility in grades nine through twelve, regardless of whether the ninth grade is included in junior high or in a senior high school. NOTE: If a student does not participate or is ineligible due to transfer, scholarship, etc., the semester(s) during that period shall be counted toward the total number of semesters possible.

Rule 17 Age Requirements—Students are eligible if they are not 19 years of age (16, 15 or 14 for junior high or middle school student) on or before September 1 of the school year in which they compete.

Rule 19 Undue Influence—The use of undue influence by any person to secure or retain a student shall cause ineligibility. If tuition is charged or reduced, it shall meet the requirements of the KSHSAA.

Rules 20/21 Amateur and Awards Rules—Students are eligible if they have not competed under a false name or for money or merchandise of intrinsic value, and have observed all other provisions of the Amateur and Awards Rules.

Rule 22 Outside Competition—Students may not engage in outside competition in the same sport during a season in which they are representing their school. NOTE: Consult the coach or principal before participating individually or on a team in any game, training session, contest, or tryout conducted by an outside organization.

Rule 25 Anti-Fraternity—Students are eligible if they are not members of any fraternity or other organization prohibited by law or by the rules of the KSHSAA.

Rule 26 Anti-Tryout and Private Instruction—Students are eligible if they have not participated in training sessions or tryouts held by colleges or other outside agencies or organizations in the same sport while a member of a school athletic team.

Rule 30 Seasons of Sport—Students are not eligible for more than four seasons in one sport in a four-year high school, three seasons in a three-year high school or two seasons in a two-year high school.

PPE shall not be taken earlier than May 1 preceding the school year for which it is applicable.

Below Are Brief Summaries Of Selected Rules. Please See Your Principal For Complete Information.


Rev. 1/15

Student’s Name (PLEASE PRINT CLEARLY)

To be eligible for participation in interscholastic athletics/spirit groups, a student must have on file with the superintendent or principal, a signed

statement by a physician, chiropractor, physician's assistant who has been authorized to perform the examination by a Kansas licensed supervising

physician or an advanced practice registered nurse who has been authorized to perform this examination by a Kansas licensed supervising physician,

certifying the student has passed an adequate physical examination and is physically fit to participate (See KSHSAA Handbook, Rule 7). A complete

history and physical examination must be performed annually before a student participates in KSHSAA interscholastic athletics/cheerleading.

The annual history and the physical examination shall not be taken earlier than May 1 preceding the school year for which it is

applicable. The KSHSAA recommends completion of this evaluation by athletes/cheerleaders at least one month prior to the first practice to allow

time for correction of deficiencies and implementation of conditioning recommendations.

Parent or Guardian Consent I do not know of any existing physical or any additional health reasons that would preclude participation in

activities. I certify that the answers to the questions in the HISTORY part of the Preparticipation Physical

Examination (PPE), are true and accurate. I approve participation in activities. I hereby authorize release to the

KSHSAA, school nurse, certified athletic trainer, school administrators, coach and medical provider of information

contained in this document. Upon written request, I may receive a copy of this document for my own personal

health care records.

I acknowledge that there are risks of participating, including the possibility of catastrophic injury.

I hereby give my consent for the above student to compete in KSHSAA approved activities, and to accompany

school representatives on school trips and receive emergency medical treatment when necessary. It is understood

that neither the KSHSAA nor the school assumes any responsibility in case of accident. The undersigned agrees

to be responsible for the safe return of all equipment issued by the school to the student.

For Middle/Junior High and Senior High School Students to Determine Eligibility When Enrolling If a negative response is given to any of the following questions, this enrollee should contact his/her administrator in charge of evaluating

eligibility. This should be done before the student is allowed to attend his/her first class and prior to the first activity practice. If questions

still exist, the school administrator should telephone the KSHSAA for a final determination of eligibility. (Schools shall process a Certificate of Transfer Form T-E on all transfer students.)

YES NO

1. Are you a bona fide student in good standing in school? (If there is a question, your principal will make that determination.)

2. Did you pass at least five new subjects (those not previously passed) last semester? (The KSHSAA has a minimum regulation which requires you to pass at least five subjects of unit weight in your last semester of attendance.)

3. Are you planning to enroll in at least five new subjects (those not previously passed) of unit weight this coming semester?

(The KSHSAA has a minimum regulation which requires you to enroll and be in attendance in at least five subjects of unit weight.)

4. Did you attend this school or a feeder school in your district last semester? (If the answer is “no” to this question, please answer Sections a and b.)

a. Do you reside with your parents?

b. If you reside with your parents, have they made a permanent and bona fide move into your school’s attendance center?

The student/parent authorizes the school to release to the KSHSAA student records and other pertinent documents and infor -

mation for the purpose of determining student eligibility. The student/parent also authorizes the school and the KSHSAA to

publish the name and picture of student as a result of participating in or attending extra-curricular activities, school events

and KSHSAA activities or events.

Parent or Guardian’s Signature Date

Student’s Signature Date Birth Date Grade

The above named student and I have read

the KSHSAA Eligibility Check List

and how to retain eligibility information listed in this form.


KSHSAA RECOMMENDED CONCUSSION & HEAD INJURY INFORMATION RELEASE

FORM

2016-2017

This form must be signed by all student athletes and parent/guardians before the student

participates in any athletic or spirit practice or contest each school year.

A concussion is a brain injury and all brain injuries are serious. They are caused by a bump, blow, or jolt to the head,

or by a blow to another part of the body with the force transmitted to the head. They can range from mild to severe

and can disrupt the way the brain normally works. Even though most concussions are mild, all concussions are

potentially serious and may result in complications including prolonged brain damage and death if not

recognized and managed properly. In other words, even a “ding” or a bump on the head can be serious. You can’t

see a concussion and most sports concussions occur without loss of consciousness. Signs and symptoms of concussion

may show up right after the injury or can take hours or days to fully appear. If your child reports any symptoms of

concussion, or if you notice the symptoms or signs of concussion yourself, seek medical attention right away.

Symptoms may include one or more of the following:

Headaches

“Pressure in head”

Nausea or vomiting

Neck pain

Balance problems or dizziness

Blurred, double, or fuzzy vision

Sensitivity to light or noise

Feeling sluggish or slowed down

Feeling foggy or groggy

Drowsiness

Change in sleep patterns

Amnesia

“Don’t feel right”

Fatigue or low energy

Sadness

Nervousness or anxiety

Irritability

More emotional

Confusion

Concentration or memory problems

(forgetting game plays)

Repeating the same question/comment

Signs observed by teammates, parents, and coaches include:

Appears dazed

Vacant facial expression

Confused about assignment

Forgets plays

Is unsure of game, score, or opponent

Moves clumsily or displays incoordination

Answers questions slowly

Slurred speech

Shows behavior or personality changes

Can’t recall events prior to hit

Can’t recall events after hit

Seizures or convulsions

Any change in typical behavior or personality

Loses consciousness

Adapted from the CDC and the 3rd International Conference in Sport

What can happen if my child keeps on playing with a concussion or returns too soon?

Athletes with the signs and symptoms of concussion should be removed from play immediately. Continuing to play with

the signs and symptoms of a concussion leaves the young athlete especially vulnerable to greater injury. There is an

increased risk of significant damage from a concussion for a period of time after that concussion occurs, particularly if the

athlete suffers another concussion before completely recovering from the first one (second impact syndrome). This can lead

to prolonged recovery, or even to severe brain swelling with devastating and even fatal consequences. It is well known that

adolescent or teenage athletes will often under report symptoms of injuries. And concussions are no different. As a result,

education of administrators, coaches, parents and students is the key for student-athlete’s safety.


If you think your child has suffered a concussion

Any athlete even suspected of suffering a concussion should be removed from the game or practice immediately. No athlete

may return to activity after sustaining a concussion, regardless of how mild it seems or how quickly symptoms clear, without

written medical clearance from a Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO). Close observation of the

athlete should continue for several hours. You should also inform your child’s coach if you think that your child may have

a concussion Remember it is better to miss one game than miss the whole season. When in doubt, the athlete sits out!

Cognitive Rest & Return to Learn

The first step to concussion recovery is cognitive rest. This is essential for the brain to heal. Activities that require

concentration and attention such as trying to meet academic requirements, the use of electronic devices (computers,

tablets, video games, texting, etc.), and exposure to loud noises may worsen symptoms and delay recovery. Students may

need their academic workload modified while they are initially recovering from a concussion. Decreasing stress on the

brain early on after a concussion may lessen symptoms and shorten the recovery time. This may involve staying home

from school for a few days, followed by a lightened school schedule, gradually increasing to normal. Any academic

modifications should be coordinated jointly between the student’s medical providers and school personnel. No

consideration should be given to returning to physical activity until the student is fully integrated back into the classroom

setting and is symptom free. Rarely, a student will be diagnosed with post-concussive syndrome and have symptoms that

last weeks to months. In these cases, a student may be recommended to start a non-contact physical activity regimen, but

this will only be done under the direct supervision of a healthcare provider.

Return to Practice and Competition

The Kansas School Sports Head Injury Prevention Act provides that if an athlete suffers, or is suspected of having

suffered, a concussion or head injury during a competition or practice, the athlete must be immediately removed from the

competition or practice and cannot return to practice or competition until a Health Care Professional has evaluated the

athlete and provided a written authorization to return to practice and competition. The KSHSAA recommends that an

athlete not return to practice or competition the same day the athlete suffers or is suspected of suffering a concussion. The

KSHSAA also recommends that an athlete’s return to practice and competition should follow a graduated protocol under

the supervision of the health care provider (MD or DO).

For current and up-to-date information on concussions you can go to:

http://www.cdc.gov/concussion/HeadsUp/youth.html

http://www.kansasconcussion.org/

For concussion information and educational resources collected by the KSHSAA, go to:

http://www.kshsaa.org/Public/General/ConcussionGuidelines.cfm

Student-athlete Name Printed Student-athlete Signature Date

Parent or Legal Guardian Printed Parent or Legal Guardian Signature Date

Revised 04/14


July 2016 Sun Mon Tue Wed Thu Fri Sat

1 2

3 4 5 6 7 8 9

10 11 online enrolment be-gins

12 13 14 15 16

17 18 Meal Benefits Application

19 20 21 22 23

24 25 26 27 28 PTSO mtg @ 1:00 in cafeteria

29 30

August 2016 Sun Mon Tue Wed Thu Fri Sat

1 2 XC Parent mtg @ 5:30

3 4 5 6

7 8 Enrollment

9:00-3:00

9 Enrollment

12:00-7:00

10 Enrollment

12:00-7:00

11 12 13

14 15 Teacher Report Dayt

16 17 18 19 20

21 22 6th Grade Sneak Preview 4:00-6:00

23 6th Grade Orientation 7:50-11:30

7/8 Open House 5-6:30

6/7/8 Block Party 6-7:30

24 First Day of School for All 7:50-3:40

25 26 27

28 29 30 PTSO & Foundation mtg

6:00

31


September 2016

Sun Mon Tue Wed Thu Fri Sat

1 2 JT Fundraiser Kickoff

3

4 5 NO SCHOOL

Labor Day

6 7 8

6th Grade Mixer 3:45-5:15

9 10

XC Meet @ Trini-ty HS

11 12 Week of Volleyball Tryouts

13 14 15 XC Meet @ Cessna Activity Center

16 17

18 19 JT Fundraiser Orders Due

20

Official Enroll-ment

XC Meet @ Cess-na Activity Center

21 22 23 24

25 26 27

Fall Picture Day—all students will be photographed

XC Meet @ Col-lege Hill Park (Robinson Eastside Classic) @ 4:00

Foundation chipotle Night

28 29

8th grade Band performs at East football game @ South HS 6:30

30

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