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December 3, 2021

7th GRADE ROCK EAGLE TRIP

Permission Form

WHO: Autrey Mill 7th graders

WHERE: Rock Eagle 4H Center, Eatonton, GA www.rockeagle4h.org

WHEN: March 18-20, 2020

HOW MUCH:  $190 per student: includes lodging, 7 meals, 6 daytime & 4 nighttime classes, charter buses (Scholarships & Payment Plans may be available, all requests need to be in writing and emailed to Dr. Gamel, 7th grade Assistant Principal at gamel@fultonschools.org)

 

If you have any questions, please contact Mrs. Nagle (nagle@fultonschools.org) or Dr. Gamel (gamel@fultonschools.org).

Additional information about the Rock Eagle Trip can be found on the Autrey Mill website along with  all the necessary forms (http://school.fultonschools.org/ms/autreymill/Pages/default.aspx). You will need your child’s student ID.  They will need to be present to sign the behavior contract.  

Please read through all of this information carefully and make sure that everything on the checklist below is taken care of by the appropriate deadlines.  Rock Eagle has a very informative website.  You can find it at www.rockeagle4h.org.  

Departure:

Students should arrive at Autrey Mill  by 7:00 AM on Wednesday, March 18th.   It will be necessary for you to arrange a ride to school for your child. Carpooling to school would be the best thing to do if at all possible.  You will find a packing list and details about luggage on the school website. 

 

Return:

We will return to Autrey Mill on Friday, March 20th around 2:00 PM.  At this time, you may check out your student.  There is a section on this form with detailed directions on how to check out your student, and who can check out your student.

 

Medicine:

If your student takes any medication you will need to fill out the authorization to give medication form.  You can find these forms on the Autrey Mill website.  Go to http://school.fultonschools.org/ms/autreymill/Pages/Clinic.aspx you will see the authorization forms.  You can turn in this form and the medication (prescription and over the counter) to Priscilla Pappo in the school clinic.  If you have any questions, please contact Priscilla Pappo at pappo@fultonschools.org.  Please see medicine information listed on separate page.

 

Food:

If your student has any dietary restrictions, please make sure to note this on the permission form.

 

Communication:

Cell phones do not always work very well, at Rock Eagle.  In the case of an emergency, you can contact the camp at 706-484-2834 and leave a message with the office during business hours.  After business hours, you may reach the night guard at 706-484-2821.

 

Damage to Rock Eagle Property:

It will be the responsibility of the parent/guardian to cover any costs incurred for damages caused by a student to cabins, equipment, or any other Rock Eagle property.

**Behavior**

Any student with three (3) or more afterschool detentions or one (1) or more In-School or Out-of-School Suspensions (during Semester 2, starting Monday, January 6th), WILL NOT be able to attend the trip.  If payment has been made, NO REFUND will be issued.

First Student's Name

First Name*

Last Name*

Phone*
First Student's Date of Birth*
I certify that I am 18 years of age or older
First Student's Information

Student Number (lunch number): *
Homeroom Teacher:*

Student Medical Insurance Information


Medical Insurance Provider (Example: BCBS, United Healthcare, etc): *

Insurance GROUP ID Number from insurance card: *

Medical Insurance MEMBER ID Number from the insurance card: *
I give permission for my child to be taken to a doctor or hospital for medical treatment should the need arise.*

Students Medication:

Prescriptions:*
Non-prescription Medication (such as antacids, antihistamines, or pain relievers)*

Allergies:

Dietary Restrictions (select one):


If Other Dietary Restrictions, please list:

Payment due by February 7, 2020 at 4:00pm. 

Payment options: Pay online through the Autrey Mill website. Please click "Online School Payments" on the homepage. 

 If a completed permission form AND payment are not received by 4:00 pm on February 7th, then your child will not be eligible to attend the field trip. 

All questions or concerns should email Dr. Mimi Gamel: gamel@fultonschools.org 

I would like to donate to the field trip scholarship fund for students in need of financial assistance.
Yes
No

If so, please give the amount in the text box and include that in amount in your student's payment.

Rock Eagle Behavior Contract

I will abide by all school rules and policies while on this field trip.  Although I am away from home, I understand that while in Rock Eagle I will be representing my school, community, and parents. Furthermore, I understand that if I disobey school rules I may be subject to appropriate consequences as outlined in the Fulton County Code of Conduct which may also include being sent home early from the field trip.  

Behavior expectations specific to the Rock Eagle trip:

Cabins:

  • Be respectful of your cabin mates and quiet hours
  • Be respectful of other's belongings
  • Be respectful of Rock Eagle cabins, equipment, or any other Rock Eagle property.
  • You are not allowed to enter or leave cabin without chaperone's permission/ supervision

Cell phone use:

  • Cell phones are not permitted on the Rock Eagle Field Trip.  If a student violates this rule, the cell phone will be collected by Dr. Gamel and can be retrieved on Monday, March 23, 2020

I have read and understand that I have to abide by the behavior expectations set forth: Any student with three (3) or more afterschool detentions or one (1) or more In-School or Out-of-School Suspensions (during Semester 2, starting Monday, January 6th), WILL NOT be able to attend the trip. If payment has been made, NO REFUND will be issued.*
Yes
First Student's Signature*
Second Student's Name

First Name*

Last Name*
Second Student's Date of Birth*
Second Student's Information

Student Number (lunch number): *
Homeroom Teacher:*

Student Medical Insurance Information


Medical Insurance Provider (Example: BCBS, United Healthcare, etc): *

Insurance GROUP ID Number from insurance card: *

Medical Insurance MEMBER ID Number from the insurance card: *
I give permission for my child to be taken to a doctor or hospital for medical treatment should the need arise.*

Students Medication:

Prescriptions:*
Non-prescription Medication (such as antacids, antihistamines, or pain relievers)*

Allergies:

Dietary Restrictions (select one):


If Other Dietary Restrictions, please list:

Payment due by February 7, 2020 at 4:00pm. 

Payment options: Pay online through the Autrey Mill website. Please click "Online School Payments" on the homepage. 

 If a completed permission form AND payment are not received by 4:00 pm on February 7th, then your child will not be eligible to attend the field trip. 

All questions or concerns should email Dr. Mimi Gamel: gamel@fultonschools.org 

I would like to donate to the field trip scholarship fund for students in need of financial assistance.
Yes
No

If so, please give the amount in the text box and include that in amount in your student's payment.

Rock Eagle Behavior Contract

I will abide by all school rules and policies while on this field trip.  Although I am away from home, I understand that while in Rock Eagle I will be representing my school, community, and parents. Furthermore, I understand that if I disobey school rules I may be subject to appropriate consequences as outlined in the Fulton County Code of Conduct which may also include being sent home early from the field trip.  

Behavior expectations specific to the Rock Eagle trip:

Cabins:

  • Be respectful of your cabin mates and quiet hours
  • Be respectful of other's belongings
  • Be respectful of Rock Eagle cabins, equipment, or any other Rock Eagle property.
  • You are not allowed to enter or leave cabin without chaperone's permission/ supervision

Cell phone use:

  • Cell phones are not permitted on the Rock Eagle Field Trip.  If a student violates this rule, the cell phone will be collected by Dr. Gamel and can be retrieved on Monday, March 23, 2020

I have read and understand that I have to abide by the behavior expectations set forth: Any student with three (3) or more afterschool detentions or one (1) or more In-School or Out-of-School Suspensions (during Semester 2, starting Monday, January 6th), WILL NOT be able to attend the trip. If payment has been made, NO REFUND will be issued.*
Yes
Second Student's Signature*
Third Student's Name

First Name*

Last Name*
Third Student's Date of Birth*
Third Student's Information

Student Number (lunch number): *
Homeroom Teacher:*

Student Medical Insurance Information


Medical Insurance Provider (Example: BCBS, United Healthcare, etc): *

Insurance GROUP ID Number from insurance card: *

Medical Insurance MEMBER ID Number from the insurance card: *
I give permission for my child to be taken to a doctor or hospital for medical treatment should the need arise.*

Students Medication:

Prescriptions:*
Non-prescription Medication (such as antacids, antihistamines, or pain relievers)*

Allergies:

Dietary Restrictions (select one):


If Other Dietary Restrictions, please list:

Payment due by February 7, 2020 at 4:00pm. 

Payment options: Pay online through the Autrey Mill website. Please click "Online School Payments" on the homepage. 

 If a completed permission form AND payment are not received by 4:00 pm on February 7th, then your child will not be eligible to attend the field trip. 

All questions or concerns should email Dr. Mimi Gamel: gamel@fultonschools.org 

I would like to donate to the field trip scholarship fund for students in need of financial assistance.
Yes
No

If so, please give the amount in the text box and include that in amount in your student's payment.

Rock Eagle Behavior Contract

I will abide by all school rules and policies while on this field trip.  Although I am away from home, I understand that while in Rock Eagle I will be representing my school, community, and parents. Furthermore, I understand that if I disobey school rules I may be subject to appropriate consequences as outlined in the Fulton County Code of Conduct which may also include being sent home early from the field trip.  

Behavior expectations specific to the Rock Eagle trip:

Cabins:

  • Be respectful of your cabin mates and quiet hours
  • Be respectful of other's belongings
  • Be respectful of Rock Eagle cabins, equipment, or any other Rock Eagle property.
  • You are not allowed to enter or leave cabin without chaperone's permission/ supervision

Cell phone use:

  • Cell phones are not permitted on the Rock Eagle Field Trip.  If a student violates this rule, the cell phone will be collected by Dr. Gamel and can be retrieved on Monday, March 23, 2020

I have read and understand that I have to abide by the behavior expectations set forth: Any student with three (3) or more afterschool detentions or one (1) or more In-School or Out-of-School Suspensions (during Semester 2, starting Monday, January 6th), WILL NOT be able to attend the trip. If payment has been made, NO REFUND will be issued.*
Yes
Third Student's Signature*
Fourth Student's Name

First Name*

Last Name*
Fourth Student's Date of Birth*
Fourth Student's Information

Student Number (lunch number): *
Homeroom Teacher:*

Student Medical Insurance Information


Medical Insurance Provider (Example: BCBS, United Healthcare, etc): *

Insurance GROUP ID Number from insurance card: *

Medical Insurance MEMBER ID Number from the insurance card: *
I give permission for my child to be taken to a doctor or hospital for medical treatment should the need arise.*

Students Medication:

Prescriptions:*
Non-prescription Medication (such as antacids, antihistamines, or pain relievers)*

Allergies:

Dietary Restrictions (select one):


If Other Dietary Restrictions, please list:

Payment due by February 7, 2020 at 4:00pm. 

Payment options: Pay online through the Autrey Mill website. Please click "Online School Payments" on the homepage. 

 If a completed permission form AND payment are not received by 4:00 pm on February 7th, then your child will not be eligible to attend the field trip. 

All questions or concerns should email Dr. Mimi Gamel: gamel@fultonschools.org 

I would like to donate to the field trip scholarship fund for students in need of financial assistance.
Yes
No

If so, please give the amount in the text box and include that in amount in your student's payment.

Rock Eagle Behavior Contract

I will abide by all school rules and policies while on this field trip.  Although I am away from home, I understand that while in Rock Eagle I will be representing my school, community, and parents. Furthermore, I understand that if I disobey school rules I may be subject to appropriate consequences as outlined in the Fulton County Code of Conduct which may also include being sent home early from the field trip.  

Behavior expectations specific to the Rock Eagle trip:

Cabins:

  • Be respectful of your cabin mates and quiet hours
  • Be respectful of other's belongings
  • Be respectful of Rock Eagle cabins, equipment, or any other Rock Eagle property.
  • You are not allowed to enter or leave cabin without chaperone's permission/ supervision

Cell phone use:

  • Cell phones are not permitted on the Rock Eagle Field Trip.  If a student violates this rule, the cell phone will be collected by Dr. Gamel and can be retrieved on Monday, March 23, 2020

I have read and understand that I have to abide by the behavior expectations set forth: Any student with three (3) or more afterschool detentions or one (1) or more In-School or Out-of-School Suspensions (during Semester 2, starting Monday, January 6th), WILL NOT be able to attend the trip. If payment has been made, NO REFUND will be issued.*
Yes
Fourth Student's Signature*
Fifth Student's Name

First Name*

Last Name*
Fifth Student's Date of Birth*
Fifth Student's Information

Student Number (lunch number): *
Homeroom Teacher:*

Student Medical Insurance Information


Medical Insurance Provider (Example: BCBS, United Healthcare, etc): *

Insurance GROUP ID Number from insurance card: *

Medical Insurance MEMBER ID Number from the insurance card: *
I give permission for my child to be taken to a doctor or hospital for medical treatment should the need arise.*

Students Medication:

Prescriptions:*
Non-prescription Medication (such as antacids, antihistamines, or pain relievers)*

Allergies:

Dietary Restrictions (select one):


If Other Dietary Restrictions, please list:

Payment due by February 7, 2020 at 4:00pm. 

Payment options: Pay online through the Autrey Mill website. Please click "Online School Payments" on the homepage. 

 If a completed permission form AND payment are not received by 4:00 pm on February 7th, then your child will not be eligible to attend the field trip. 

All questions or concerns should email Dr. Mimi Gamel: gamel@fultonschools.org 

I would like to donate to the field trip scholarship fund for students in need of financial assistance.
Yes
No

If so, please give the amount in the text box and include that in amount in your student's payment.

Rock Eagle Behavior Contract

I will abide by all school rules and policies while on this field trip.  Although I am away from home, I understand that while in Rock Eagle I will be representing my school, community, and parents. Furthermore, I understand that if I disobey school rules I may be subject to appropriate consequences as outlined in the Fulton County Code of Conduct which may also include being sent home early from the field trip.  

Behavior expectations specific to the Rock Eagle trip:

Cabins:

  • Be respectful of your cabin mates and quiet hours
  • Be respectful of other's belongings
  • Be respectful of Rock Eagle cabins, equipment, or any other Rock Eagle property.
  • You are not allowed to enter or leave cabin without chaperone's permission/ supervision

Cell phone use:

  • Cell phones are not permitted on the Rock Eagle Field Trip.  If a student violates this rule, the cell phone will be collected by Dr. Gamel and can be retrieved on Monday, March 23, 2020

I have read and understand that I have to abide by the behavior expectations set forth: Any student with three (3) or more afterschool detentions or one (1) or more In-School or Out-of-School Suspensions (during Semester 2, starting Monday, January 6th), WILL NOT be able to attend the trip. If payment has been made, NO REFUND will be issued.*
Yes
Fifth Student's Signature*
Sixth Student's Name

First Name*

Last Name*
Sixth Student's Date of Birth*
Sixth Student's Information

Student Number (lunch number): *
Homeroom Teacher:*

Student Medical Insurance Information


Medical Insurance Provider (Example: BCBS, United Healthcare, etc): *

Insurance GROUP ID Number from insurance card: *

Medical Insurance MEMBER ID Number from the insurance card: *
I give permission for my child to be taken to a doctor or hospital for medical treatment should the need arise.*

Students Medication:

Prescriptions:*
Non-prescription Medication (such as antacids, antihistamines, or pain relievers)*

Allergies:

Dietary Restrictions (select one):


If Other Dietary Restrictions, please list:

Payment due by February 7, 2020 at 4:00pm. 

Payment options: Pay online through the Autrey Mill website. Please click "Online School Payments" on the homepage. 

 If a completed permission form AND payment are not received by 4:00 pm on February 7th, then your child will not be eligible to attend the field trip. 

All questions or concerns should email Dr. Mimi Gamel: gamel@fultonschools.org 

I would like to donate to the field trip scholarship fund for students in need of financial assistance.
Yes
No

If so, please give the amount in the text box and include that in amount in your student's payment.

Rock Eagle Behavior Contract

I will abide by all school rules and policies while on this field trip.  Although I am away from home, I understand that while in Rock Eagle I will be representing my school, community, and parents. Furthermore, I understand that if I disobey school rules I may be subject to appropriate consequences as outlined in the Fulton County Code of Conduct which may also include being sent home early from the field trip.  

Behavior expectations specific to the Rock Eagle trip:

Cabins:

  • Be respectful of your cabin mates and quiet hours
  • Be respectful of other's belongings
  • Be respectful of Rock Eagle cabins, equipment, or any other Rock Eagle property.
  • You are not allowed to enter or leave cabin without chaperone's permission/ supervision

Cell phone use:

  • Cell phones are not permitted on the Rock Eagle Field Trip.  If a student violates this rule, the cell phone will be collected by Dr. Gamel and can be retrieved on Monday, March 23, 2020

I have read and understand that I have to abide by the behavior expectations set forth: Any student with three (3) or more afterschool detentions or one (1) or more In-School or Out-of-School Suspensions (during Semester 2, starting Monday, January 6th), WILL NOT be able to attend the trip. If payment has been made, NO REFUND will be issued.*
Yes
Sixth Student's Signature*
Seventh Student's Name

First Name*

Last Name*
Seventh Student's Date of Birth*
Seventh Student's Information

Student Number (lunch number): *
Homeroom Teacher:*

Student Medical Insurance Information


Medical Insurance Provider (Example: BCBS, United Healthcare, etc): *

Insurance GROUP ID Number from insurance card: *

Medical Insurance MEMBER ID Number from the insurance card: *
I give permission for my child to be taken to a doctor or hospital for medical treatment should the need arise.*

Students Medication:

Prescriptions:*
Non-prescription Medication (such as antacids, antihistamines, or pain relievers)*

Allergies:

Dietary Restrictions (select one):


If Other Dietary Restrictions, please list:

Payment due by February 7, 2020 at 4:00pm. 

Payment options: Pay online through the Autrey Mill website. Please click "Online School Payments" on the homepage. 

 If a completed permission form AND payment are not received by 4:00 pm on February 7th, then your child will not be eligible to attend the field trip. 

All questions or concerns should email Dr. Mimi Gamel: gamel@fultonschools.org 

I would like to donate to the field trip scholarship fund for students in need of financial assistance.
Yes
No

If so, please give the amount in the text box and include that in amount in your student's payment.

Rock Eagle Behavior Contract

I will abide by all school rules and policies while on this field trip.  Although I am away from home, I understand that while in Rock Eagle I will be representing my school, community, and parents. Furthermore, I understand that if I disobey school rules I may be subject to appropriate consequences as outlined in the Fulton County Code of Conduct which may also include being sent home early from the field trip.  

Behavior expectations specific to the Rock Eagle trip:

Cabins:

  • Be respectful of your cabin mates and quiet hours
  • Be respectful of other's belongings
  • Be respectful of Rock Eagle cabins, equipment, or any other Rock Eagle property.
  • You are not allowed to enter or leave cabin without chaperone's permission/ supervision

Cell phone use:

  • Cell phones are not permitted on the Rock Eagle Field Trip.  If a student violates this rule, the cell phone will be collected by Dr. Gamel and can be retrieved on Monday, March 23, 2020

I have read and understand that I have to abide by the behavior expectations set forth: Any student with three (3) or more afterschool detentions or one (1) or more In-School or Out-of-School Suspensions (during Semester 2, starting Monday, January 6th), WILL NOT be able to attend the trip. If payment has been made, NO REFUND will be issued.*
Yes
Seventh Student's Signature*
Eighth Student's Name

First Name*

Last Name*
Eighth Student's Date of Birth*
Eighth Student's Information

Student Number (lunch number): *
Homeroom Teacher:*

Student Medical Insurance Information


Medical Insurance Provider (Example: BCBS, United Healthcare, etc): *

Insurance GROUP ID Number from insurance card: *

Medical Insurance MEMBER ID Number from the insurance card: *
I give permission for my child to be taken to a doctor or hospital for medical treatment should the need arise.*

Students Medication:

Prescriptions:*
Non-prescription Medication (such as antacids, antihistamines, or pain relievers)*

Allergies:

Dietary Restrictions (select one):


If Other Dietary Restrictions, please list:

Payment due by February 7, 2020 at 4:00pm. 

Payment options: Pay online through the Autrey Mill website. Please click "Online School Payments" on the homepage. 

 If a completed permission form AND payment are not received by 4:00 pm on February 7th, then your child will not be eligible to attend the field trip. 

All questions or concerns should email Dr. Mimi Gamel: gamel@fultonschools.org 

I would like to donate to the field trip scholarship fund for students in need of financial assistance.
Yes
No

If so, please give the amount in the text box and include that in amount in your student's payment.

Rock Eagle Behavior Contract

I will abide by all school rules and policies while on this field trip.  Although I am away from home, I understand that while in Rock Eagle I will be representing my school, community, and parents. Furthermore, I understand that if I disobey school rules I may be subject to appropriate consequences as outlined in the Fulton County Code of Conduct which may also include being sent home early from the field trip.  

Behavior expectations specific to the Rock Eagle trip:

Cabins:

  • Be respectful of your cabin mates and quiet hours
  • Be respectful of other's belongings
  • Be respectful of Rock Eagle cabins, equipment, or any other Rock Eagle property.
  • You are not allowed to enter or leave cabin without chaperone's permission/ supervision

Cell phone use:

  • Cell phones are not permitted on the Rock Eagle Field Trip.  If a student violates this rule, the cell phone will be collected by Dr. Gamel and can be retrieved on Monday, March 23, 2020

I have read and understand that I have to abide by the behavior expectations set forth: Any student with three (3) or more afterschool detentions or one (1) or more In-School or Out-of-School Suspensions (during Semester 2, starting Monday, January 6th), WILL NOT be able to attend the trip. If payment has been made, NO REFUND will be issued.*
Yes
Eighth Student's Signature*
Ninth Student's Name

First Name*

Last Name*
Ninth Student's Date of Birth*
Ninth Student's Information

Student Number (lunch number): *
Homeroom Teacher:*

Student Medical Insurance Information


Medical Insurance Provider (Example: BCBS, United Healthcare, etc): *

Insurance GROUP ID Number from insurance card: *

Medical Insurance MEMBER ID Number from the insurance card: *
I give permission for my child to be taken to a doctor or hospital for medical treatment should the need arise.*

Students Medication:

Prescriptions:*
Non-prescription Medication (such as antacids, antihistamines, or pain relievers)*

Allergies:

Dietary Restrictions (select one):


If Other Dietary Restrictions, please list:

Payment due by February 7, 2020 at 4:00pm. 

Payment options: Pay online through the Autrey Mill website. Please click "Online School Payments" on the homepage. 

 If a completed permission form AND payment are not received by 4:00 pm on February 7th, then your child will not be eligible to attend the field trip. 

All questions or concerns should email Dr. Mimi Gamel: gamel@fultonschools.org 

I would like to donate to the field trip scholarship fund for students in need of financial assistance.
Yes
No

If so, please give the amount in the text box and include that in amount in your student's payment.

Rock Eagle Behavior Contract

I will abide by all school rules and policies while on this field trip.  Although I am away from home, I understand that while in Rock Eagle I will be representing my school, community, and parents. Furthermore, I understand that if I disobey school rules I may be subject to appropriate consequences as outlined in the Fulton County Code of Conduct which may also include being sent home early from the field trip.  

Behavior expectations specific to the Rock Eagle trip:

Cabins:

  • Be respectful of your cabin mates and quiet hours
  • Be respectful of other's belongings
  • Be respectful of Rock Eagle cabins, equipment, or any other Rock Eagle property.
  • You are not allowed to enter or leave cabin without chaperone's permission/ supervision

Cell phone use:

  • Cell phones are not permitted on the Rock Eagle Field Trip.  If a student violates this rule, the cell phone will be collected by Dr. Gamel and can be retrieved on Monday, March 23, 2020

I have read and understand that I have to abide by the behavior expectations set forth: Any student with three (3) or more afterschool detentions or one (1) or more In-School or Out-of-School Suspensions (during Semester 2, starting Monday, January 6th), WILL NOT be able to attend the trip. If payment has been made, NO REFUND will be issued.*
Yes
Ninth Student's Signature*
Tenth Student's Name

First Name*

Last Name*
Tenth Student's Date of Birth*
Tenth Student's Information

Student Number (lunch number): *
Homeroom Teacher:*

Student Medical Insurance Information


Medical Insurance Provider (Example: BCBS, United Healthcare, etc): *

Insurance GROUP ID Number from insurance card: *

Medical Insurance MEMBER ID Number from the insurance card: *
I give permission for my child to be taken to a doctor or hospital for medical treatment should the need arise.*

Students Medication:

Prescriptions:*
Non-prescription Medication (such as antacids, antihistamines, or pain relievers)*

Allergies:

Dietary Restrictions (select one):


If Other Dietary Restrictions, please list:

Payment due by February 7, 2020 at 4:00pm. 

Payment options: Pay online through the Autrey Mill website. Please click "Online School Payments" on the homepage. 

 If a completed permission form AND payment are not received by 4:00 pm on February 7th, then your child will not be eligible to attend the field trip. 

All questions or concerns should email Dr. Mimi Gamel: gamel@fultonschools.org 

I would like to donate to the field trip scholarship fund for students in need of financial assistance.
Yes
No

If so, please give the amount in the text box and include that in amount in your student's payment.

Rock Eagle Behavior Contract

I will abide by all school rules and policies while on this field trip.  Although I am away from home, I understand that while in Rock Eagle I will be representing my school, community, and parents. Furthermore, I understand that if I disobey school rules I may be subject to appropriate consequences as outlined in the Fulton County Code of Conduct which may also include being sent home early from the field trip.  

Behavior expectations specific to the Rock Eagle trip:

Cabins:

  • Be respectful of your cabin mates and quiet hours
  • Be respectful of other's belongings
  • Be respectful of Rock Eagle cabins, equipment, or any other Rock Eagle property.
  • You are not allowed to enter or leave cabin without chaperone's permission/ supervision

Cell phone use:

  • Cell phones are not permitted on the Rock Eagle Field Trip.  If a student violates this rule, the cell phone will be collected by Dr. Gamel and can be retrieved on Monday, March 23, 2020

I have read and understand that I have to abide by the behavior expectations set forth: Any student with three (3) or more afterschool detentions or one (1) or more In-School or Out-of-School Suspensions (during Semester 2, starting Monday, January 6th), WILL NOT be able to attend the trip. If payment has been made, NO REFUND will be issued.*
Yes
Tenth Student's Signature*
Parent or Guardian's Email Address

Email*

Confirm Email*
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Check out procedure for Friday, March 20, 2020

Students returning from Rock Eagle will be allowed to check out upon return on March 20, 2020.  These students will be counted present for the entire day and will not have to make up any assignments.You will be able to check out your student from the gym/cafeteria until 2:30pm.  

Once the doors open, please stand in the appropriate line by student's last name to help things move quickly. Parents will be able to pick up their student in the gym (Last Names A-L) or the cafeteria (Last Names M-Z).

Note that students will only be allowed to be checked out by a parent or the person indicated below (you can list several names).  If a parent or person is not listed below, they will not be allowed to check out and pick up the student. 

My student will remain at school.
I will check out my student upon arrival to the school (2 PM).

My student will be checked out by: (first and last names of each approved person)

*If anything changes at any point (up until noon on March 20th) and a different person will be picking up your child, please email Mrs. Kathy Nagle at nagle@fultonschools.org.


Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information

Student Number (lunch number): *
Homeroom Teacher:*

Student Medical Insurance Information


Medical Insurance Provider (Example: BCBS, United Healthcare, etc): *

Insurance GROUP ID Number from insurance card: *

Medical Insurance MEMBER ID Number from the insurance card: *
I give permission for my child to be taken to a doctor or hospital for medical treatment should the need arise.*

Students Medication:

Prescriptions:*
Non-prescription Medication (such as antacids, antihistamines, or pain relievers)*

Allergies:

Dietary Restrictions (select one):


If Other Dietary Restrictions, please list:

Payment due by February 7, 2020 at 4:00pm. 

Payment options: Pay online through the Autrey Mill website. Please click "Online School Payments" on the homepage. 

 If a completed permission form AND payment are not received by 4:00 pm on February 7th, then your child will not be eligible to attend the field trip. 

All questions or concerns should email Dr. Mimi Gamel: gamel@fultonschools.org 

I would like to donate to the field trip scholarship fund for students in need of financial assistance.
Yes
No

If so, please give the amount in the text box and include that in amount in your student's payment.

Rock Eagle Behavior Contract

I will abide by all school rules and policies while on this field trip.  Although I am away from home, I understand that while in Rock Eagle I will be representing my school, community, and parents. Furthermore, I understand that if I disobey school rules I may be subject to appropriate consequences as outlined in the Fulton County Code of Conduct which may also include being sent home early from the field trip.  

Behavior expectations specific to the Rock Eagle trip:

Cabins:

  • Be respectful of your cabin mates and quiet hours
  • Be respectful of other's belongings
  • Be respectful of Rock Eagle cabins, equipment, or any other Rock Eagle property.
  • You are not allowed to enter or leave cabin without chaperone's permission/ supervision

Cell phone use:

  • Cell phones are not permitted on the Rock Eagle Field Trip.  If a student violates this rule, the cell phone will be collected by Dr. Gamel and can be retrieved on Monday, March 23, 2020

I have read and understand that I have to abide by the behavior expectations set forth: Any student with three (3) or more afterschool detentions or one (1) or more In-School or Out-of-School Suspensions (during Semester 2, starting Monday, January 6th), WILL NOT be able to attend the trip. If payment has been made, NO REFUND will be issued.*
Yes
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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