SENIOR WEEKEND JOIN THE FUN THIS FALL! OCTOBER 19TH-21ST. -A WEEKEND AT CAMP SCICONHigh School Seniors will have the opportunity


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1 SENIOR WEEKEND 2018 JOIN THE FUN THIS FALL! OCTOBER 19TH-21ST -A WEEKEND AT CAMP SCICONHigh School Seniors will have the opportunity to GETAWAY AND ENJOY THE BEAUTIFUL outdoors OF THE NATIONAL SEQUOIA PARK while preparing for college. FINANCIAL AID Hands on help filling out FAFSA and Dream Act Application. please bring all required documentation: -parents'2017 tax return W'2's -students' social security) UC/CSU APPLICATION AND TRANSFER PROCESS On-site assistance filling out the UC,/CSU application, AND community college application. -please bring high school transcripts. LEADERSHIP DEVELOPMENT Students will have the opportunity to gain CULTURAL AWARENESS AND leadership skills through educational activities AND MOTIVATIONAL SPEAKERS. For the application, visit our website at or for more information contact our office at Students will be entered for a chance to win an ipad & other prizes!

2 Fin de Semana para estudiantes del doce grado 2018 Ú N E T E A L A D I V E R S I Ó N E S T E O T O Ñ O! DE OCTUBRE - U N F I N D E S E M A N A E N C A M P S C I C O N - E S T U D I A N T E S D E L D O C E G R A D O T E N D R A N L A O P O R T U N I D A D d e d i s f r u t a r l a b e l l a n a t u r a l e z a d e l p a r q u e n a c i o n a l d e s e q u o i a m i e n t r a s s e p r e p a r a n p a r a l a u n i v e r s i d a d. ayuda financiera estaremos ofreciondo ayuda para completer la solicitud de fafsa/y ca dream act. Favor de traer los documentos requeridos:: -impuestos del W'2' Del seguro social del estudiante) solicitud de Uc,cSU, y proceso de transferencia asistencia para completar la solicitud de uc, csu, y colegio comunitario. -favor de traer una copia de transcripcion de la secundaria. desarrollo de liderazgo los estudiantes tendran la oportunidad de desarrollar su consciencia cultural y habilidades de liderazgo a mediante de actividades educacionales y oradores motivacionales. Para completar la aplicacion, visite nuestra pagina de web o para más informacion comuniquese a nuestra oficina Los estudiantes tendran la oportunidad de ganarse un ipad y otros premios!

3 Dear Students and Parents, Annually, the Youth 2 Leaders Education Foundation and the Migrant Education Program, Region V, offers a very special program for high school students. High school students have the opportunity to participate in a three-day pre-college program, which will prepare them for college and beyond. This program will take place at Camp SCICON in Springville, CA from Oct. 19 th Oct 21 st. The focus is on students completing college admissions applications and Financial Aid applications. Other activities will include engaging with fellow peers through various leadership and networking activities. The goal is for the students to leave the camp with a majority of their applications complete. *It is important for the students to come prepared with the required documents: Parents 2017 tax returns, student transcripts. This entire program is absolutely Free! The Migrant Education Program, Region V, pays for meals, lodging, and transportation. To be considered for this program, contact the Migrant Resource Teacher at your school. Don t miss out on this enriching experience! ELIGIBILITY To be eligible for this unique experience you must: Be a high school student in the 12 th grade. Be enrolled in the Migrant Education Program. Have demonstrated academic and leadership potential. APPLICATION DEADLINE: Submit a completed application on or before Tuesday, October 9, Estimados Padres e Estudiantes, Anualmente, la fundacion Youth 2 Leaders y el Programa Migrante, Regiόn V, ofrece un programa muy especial. Estudiantes de la preparatoria tendran la oportunidad de participar en un programa de 3 días que preparará a su hijo o hija para el colegio. Este programa se llevará a cabo en el campamento SCICON en Springville, CA de oct. 19 oct. 21. El enfoque está en que los estudiantes completan aplicaciones de admisión a la universidad y aplicaciones de Ayuda Financiera. Otras actividades incluirán la participación de otros compañeros a través de diversas actividades de liderazgo. El objetivo es que los estudiantes abandonen el campamento con la mayoría de sus aplicaciones completas. *Para asegurar esto es importante que estudiantes vengan preparados con los documentos correctos.: Taxes de los padres del 2017 y transcripciones de la escuela del estudiante. Este programa de instrucción será absolutamente grátis. Los alimentos, el alojamiento y la transportación serán pagados por una beca del Programa de Educación Migrante. Para ser considerado para este programa, favor de ponerse en contacto con su consejero o coordinador del Programa de Educación Migrante. No pierdan esta gran oportunidad! ELEGIBILIDAD Para ser eligible para el programa de este campamento debe ser: Matriculado en el programa migrante. Estudiante de la preparatoria en el grado 12. Haber demostrado cualidades de liderazgo y académicas. PLAZO DE SOLICITUD: Enviar solicitud completada el o antes de Martes, 9 de octubre del

4 CHECK OFF LIST FOR COMPLETING APPLICATION *All of the check list components must be signed by parent or guardian or application will be marked as incomplete. Migrant Pre-College Camp Student Application Form is completed Your parental permission & liability waiver form Your photo release form Your indemnity agreement form Your medication consent form Submit completed application on or before Tuesday, October 9, 2018 before the end of instruction. Incomplete or late applications will not be considered or accepted. Enviar solicitud completada el o antes de Martes, 9 de octubre del Aplicaciones incompletas or tardes no seran consideradas. 2

5 SUGGESTED CLOTHING CHECKLIST The following is a list of clothing and equipment we suggest you bring to the Pre-College Camp. It is suggested that luggage be planned to include only a sleeping bag or a blanket and a suitcase or duffel bag. We suggest that pants are worn at the camp at all times due to mosquitos being present. All clothing should be labeled with the owner s name. La siguiente es una lista de ropa y equipaje que le ayudara durante su campamento. Por favor de traer una bolsa de dormir o cobijas y una maleta o bolsa para la ropa. Traiga estas cosas el primer día de campamento. Tambíen se le sugerir a los estudiantes traer puros pantalones por la precensia de mosqitos en el campamento. Toda la ropa y propiedad debe ser identificada con el nombre de su dueño. Por favor, traiga su ropa más vieja. Pajamas /Ropa de dormir Boots and tennis shoes/botas y tenis Socks/Calcetines Pants (2)/ Pantalones (2) Jacket and/or sweater/ Chamarra y suéter Girls blouses (2)/ Muchachas blusas (2) Boys shirts (2)/ Muchachos camisas (2) Underwear (2)/ Ropa Interior (2) Comb/ Peine Towel/ Toalla Toothbrush and toothpaste/ Pasta dental y cepillo de dientes Soap/ Jabón *Warm blanket or sleeping bag/2 cobijas o bolsa de dormir Flashlight/ Linterna Hat/Gorra Plastic container for water/botella plástica para agua *SLEEPING BAGS WILL NOT BE PROVIDED/NO HABRA BOLSAS DE DORMIR PLEASE DO NOT BRING: Pocketknives, radios, candy, gum or other kind of food. POR FAVOR NO TRAIGAN: Navajas, radios, dulce, chicle, o ningún otro tipo de comida. *Bags are subject to security check/maletas serán revisadas por seguridad de control. 3

6 APPLICANT INFORMATION Last Name First Name M.I. Street Address Apartment/Unit # City State ZIP Phone Address MSID# Gender Date of Birth Parent Name Emergency Contact Name SCHOOL INFORMATION High School Parent Contact Number Incoming Grade Emergency Contact Number GPA (9-12, weighted) EXTRACURRICULAR ACTITIVIES SAT/ACT Scores (if applicable) Tell us about your extracurricular activities in and outside of school. For example, class office, clubs, organizations, sports, hobbies, church, work experience, etc. Activity (Please describe the activity below. Please include the dates and grade level of when activity occurred) Activity (Please describe the activity below. Please include the dates and grade level of when activity occurred) Activity (Please describe the activity below. Please include the dates and grade level of when activity occurred) EDUCATIONAL AND CAREER GOALS Describe your career goals. List the college(s)/university(s) you plan to apply to and/or attend. 4

7 K E R N C O U N T Y S U P E R I N T E N D E N T O F S C H O O L S M I G R A N T E D U C A T I O N P R O G R A M PARENTAL PERMISSION AND LIABILITY WAIVER 1.Migrant Education Pre-College Camp 2. On behalf of themselves individually, their child/children, spouses, respective heirs, agents, representatives, and assigns, by their signatures below, the parents agree: A. Exculpatory Release: To waive any claim or cause of action in favor of their child and/or themselves against the Kern County Superintendent of Schools, as well as Migrant Education Region V and the State of California (including their respective, officers, administrators, agents, employees, independent contractors, subcontractors, consultants, volunteers, and other representatives) and/or against the Kern County Board of Education (Including its officers, administrators, agents, employees, independent contractors, subcontractors, consultants, volunteers, and other representatives), hereinafter all jointly referred to as KCSOS/KCBE, which may occur in conjunction with their participation or their child s participation in the described activity. B.Express Assumption of the Risk: To undertake all the risk of injury, of any nature, to their child and/or to themselves should any occur in conjunction with their participation or their child s participation in the described activity. C.Hold Harmless and Indemnification: To defend, hold harmless, and indemnify KCSOS/KCBE from and against any and all claims or causes of action in favor of their child or themselves which may occur in conjunction with their participation or their child s participation in the described activity. Covenant Not to Sue: Not to sue KCSOS/KCBE for any claim or cause of action which may occur in favor of their child and/or themselves as the result of their participation or their child s participation in the described activity. I authorize my son or daughter to participate in the Migrant Education Pre-College camp, which is held at Camp SCICON in Springville, CA. Student Name: Name of Parent or Legal Guardian: Signature of Parent or Legal Guardian: Date: This form is required to attend the program. Se requiere esta forma para poder asistir al programa. 5

8 K E R N C O U N T Y S U P E R I N T E N D E N T O F S C H O O L S M I G R A N T E D U C A T I O N P R O G R A M PHOTO RELEASE FORM I hereby grant the Migrant Education Program Region V, the Kern County Superintendent of Schools, the Youth 2 Leaders Education Foundation permission to use my likeness in photographs and/or video in any and all of its publications, including web space, and in any and all other media, whether now known or hereafter existing, controlled by Migrant Education Program Region V, Kern County Superintendent of Schools, Youth 2 Leaders Education Foundation in perpetuity, and for other use by the program or county office of education. I will make no monetary or other claim against Migrant Education Program Region V, Kern County Superintendent of Schools and/or Youth 2 Leaders Education Foundation for the use of the photographs and/or video. Por la presente otorgo el Programa de Educación Migrante Región V y el Superintendente del Condado de Kern Escuelas el permiso para usar mi imagen en las fotografías y/o video en todas y cada una de sus publicaciones, incluyendo el espacio web, y en cualquier y todos los demás medios de comunicación, ya sea conocido o adelante existente, controlado por Migrant Education Program Región V y Kern Superintendente de Escuelas del Condado, a perpetuidad, y para otros usos en el programa o en la oficina de educación del condado. No haré ninguna reclamación económica o de otro tipo contra Migrant Education Program Región V y/o Kern Superintendente de Escuelas del Condado para el uso de las fotografías y / o video. Student Name (print full Name) Student Signature Date Parent s Signature (if grantor is under18) Date This form is required to attend the program. Se requiere esta forma para poder asistir al programa. 6

9 K E R N C O U N T Y S U P E R I N T E N D E N T O F S C H O O L S M I G R A N T E D U C A T I O N P R O G R A M INDEMNITY AGREEMENT I am aware that my child has chosen to enroll and participate in the Pre-College camp which he/she will have the option to participate in educational training activities, which are physically, mentally or emotionally demanding and may contain risks. My child agrees to obey all rules, policies and regulations of the program. I understand that participants must behave according to regulations governing conduct during their stay at the program. Any violation of rules and regulations will result in a phone call to the parents by the administrator of the program to arrange transportation home of the student, taking into account any expense arising based on the student's expulsion will be paid by the parent. By signing this form means you agree to hold harmless Kern County Superintendent of Schools its officers, officials, agents and employees, individually and collectively, against all costs, losses, demands, actions, payments and judgments, including legal costs and attorneys' fees arising in connection with this program, including any bodily or personal injury, property or other damage, however caused, or brought or recovered against any of those already mentioned above. Yo estoy conciente que mi hijo(a) ha escogido matricularse y participar en el programa de Pre-College camp, en el cual él/ella tendrá la opción de participar en actividades de entrenamiento educativas, las cuales son física, mental ó emocionalmente exigentes y podrán contener riesgos. Mi hijo(a) está de acuerdo en que debe obedecer todas las reglas, normas y regulaciones de todas las actividades. Yo comprendo que los participantes deben comportarse según los reglamentos que gobiernan la conducta durante su estancia en el campamento. Cualquier violación de las reglas y regulaciones resultará en una llamada telefónica a los padres de parte del administrador del campamento para arreglar la transportación a casa del estudiante, tomando en cuenta que cualquier gasto que surja a base de la expulsión del estudiante será pagado por el padre. Al firmar al pie de esta forma significa que estoy de acuerdo en librar de culpa a Kern County Superintendent of Schools su mesa directiva, oficiales, agentes y empleados, individualmente y colectivamente, contra cualquier costo, pérdida, demanda, acción, pagos y fallos, incluyendo costos legales y de abogados que surjan en conexión con el programa al aire libre, incluyendo cualesquier lesiones personales ó corporales, propiedad u otro daño, no obstante causado, ó traído ó recuperado contra cualesquiera de los ya mencionado anteriormente. Student Name: Name of Parent or Legal Guardian: Signature of Parent or Legal Guardian: Date/Fecha: This form is required to attend the program. Se requiere esta forma para poder asistir al programa. 7

10 K E R N C O U N T Y S U P E R I N T E N D E N T O F S C H O O L S M I G R A N T E D U C AT I O N P R O G R A M MEDICATION CONSENT FORM I am the parent or guardian of (student): Allergies or current medical problems: I direct the Migrant Education Program (MEP) staff to assist my child in taking medication with the written statement/prescription of the physician. I agree to indemnify and hold harmless the Kern County Office of Education, its officers, agents, and employees, for any injury, illness or death which may occur as a result of assisting with administration of the medication in accordance with the physician s direction. Parent/Guardian Signature Date Name (Typed or Printed) Emergency Phone Physician s Statement & Directions Name of Student: School: Grade: Name of Medication: Dosage: Time/Frequency: Method of Administration: [] Tablets [] Liquid [] Inhaler [] Other: Reason for Medication: Possible Side Effects: Estimated Termination Date: CHECK WHICH OPTION APPLIES AND IS RECOMMENDED BY PHYSICIAN: [ ] Medication should be administered under adult supervision in the office. [ ] There is a significant potential of an urgent need for this medication at unpredictable times, AND the child has shown to me the maturity, ability and knowledge to carry and self-administer this medication per my instructions. Physician s Signature (Typed/Printed) Phone Physician s Name Date This form is required to attend the program. Se requiere esta forma para poder asistir al programa. Reference: California Education Code

11 Field Trips Office of Mary C. Barlow Kern County Superintendent of Schools Migrant Education, Region V October 19-21, 2018 SCICON- Senior Retreat Bus transportation provided by Charter Bus Any questions please call Sal Avalos at Parent Authorization For Transport Student Name School Attending Parent/Guardian Name Emergency Contact Numbers: (Home) (Cell) (Other) In the event that I, the undersigned Parent/Guardian of the Teen named, above, cannot provide transportation for the Teen to and from appointments and/or services, or related school activities, the undersigned hereby authorizes, assumes the risk of, if any, and waives and releases and discharges the Agency and its past, present and future officers, directors, agents, employees, affiliates, and partners from, and relinquishes, any and all past, present, or future claims, demands, obligations, or causes of action for, compensatory or punitive damages, costs, losses, expenses, and compensation, whether based on tort, contract, or any other theories of recovery, which the undersigned has or which may later accrue to or be acquired by the undersigned against the, for the injury, including death, to the above-mentioned Teen, arising from the transportation of the Teen as authorized herein. Parent/Guardian Initials EMERGENCY TREATMENT The following language, when executed by Parent/Guardian, will constitute a legal and binding authorization for the school, its Director and other authorized agents, hospitals and other medical providers, to provide medical treatment to the named teen and/or child of the named teen in the event of an accident, and when Parent/Guardian cannot be located for consent to treatment. The original of this form will be retained by the Site Administrator or other program staff, and a copy of this form may be used in all respects, and carries the same force and effect, as an original. I, the undersigned Parent/Guardian of [insert name of Teen] do hereby consent to any X-ray examination, medical treatment or hospitalization deemed advisable, at my expense, which is to be rendered under the general or special supervision of any licensed physician or medical practitioner of any licensed hospital. This authorization shall remain in effect for one year from the date below written. PARENT/GUARDIAN NAME [Please print] Parent/Guardian Initials PARENT/GUARDIAN SIGNATURE Date Address: