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To Parents:
Hammond
Operation Snowball brings together teenagers and adults in a
cooperative effort to prevent chemical dependency and other kinds of
destructive behavior. Operation Snowball helps to develop a
positive self-image, leadership and communication skills.
Teens from many schools meet to share ideas, to learn from each
other and to HAVE FUN.
THIS IS NOT A TREATMENT PROGRAM.
It focuses on attitudes, feelings and information. Security is
provided by chaperoning adults at all times. An EMT will be on
duty at the event for the entire weekend.
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REGISTRATION:
Please print-out and complete the application (on the next page) and
return it to:
SANDY DZIEPAK
832
- 169th PLACE
Hammond, IN 46323
The application deadline is October
16, 2000. If you have any
questions, please call (219)933-4860.
The cost is $40.00 before deadline and $50.00 at the door.
All participants are expected to register at
6:00pm on October 26, 2000 at Gavit High School Hammond, IN.
The program begins promptly at 6:30pm. No dinner will be
served.
THINGS TO BRING:
Sleeping bag, pillow, bath and personal hygiene items, towels &
wash clothes.
THINGS NOT TO BRING:
Food, radios, beepers, cell phones, TV or anything of value.
Hammond Operation Snowball cannot be held responsible for lost or
stolen items. This includes money.
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PLEASE LEAVE
THESE ITEMS AT HOME
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CLOSING:
Please come to Gavit High School on Sunday October 29th, 2000 at
11:00am for a brief closing program.
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THIS APPLICATION IS DUE ON OR
BEFORE
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OCTOBER 16,
2000
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| HAMMOND
OPERATION SNOWBALL RULES |
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1.
All keys need to be turned in to the Snowball staff during
registration for security reasons.
2. All medications need to be turned in to the staff health
coordinator at the time of registration. Prescription drugs will be
despensed as indicated on the prescription container by the staff
health coordinator. If alcohol or other drug use is suspected and
confirmed, the participant will be asked to leave. The parent or
guardian will be notified.
3. Participants will NOT be permitted to leave the grounds, during
the event, without the permission of one of the Adult Directors and
previous approval from parent or guardian in writing.
4. All visitors to the Snowball site must be preapproved and must
register with an Adult Director when arriving to Snowball.
5. At no time will males and females be permitted in the rooms of
the opposite sex without specific authorization from an Adult
Director.
6. Operation Snowball will not be responsible for personal items
lost or stolen. This includes money.
7. Particiants are expected to participate in all scheduled
activities.
8. Participants should immediately notify a staff member in the
event of illness or injury. Participant's parent or guardian will be
notified by the Snowball health coordinator, in the event of serious
injury or illness.
9. Participants will be expected to use good judgment in all
activities, including recreation.
10. Participants will be expected to demonstrate respect,
consideration and concern for participants and staff during the
event.
11. Any discussion of abuse or suicide must be reported to one of
the Adult Directors immediately.
12. Hats, gang related paraphernalia, beepers, and cell phones are
prohibited from the event. |
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Infraction
of any of the above may lead to immediate dismissal from the event.
In the case of dismissal, parents will be notified, to pick the
participant up immediately. |
NAME:______________________________ HOME PHONE:_______________
ADDRESS:__________________________ CITY:_____________STATE:____
ZIP CODE:__________ TEEN____ ADULT____ MALE____ FEMALE____ EMAIL
ADDRESS:_______________________________
SCHOOL:________________ GRADE:_______
FORM OF PAYMENT: CASH____ CHECK_____ SCHOOL PAYMENT_____
Is this your first Snowball? YES_____ NO_____
SPECIAL DIETARY REQUIREMENTS:_____________________
EMERGENCY CONTACT:________________________________
ADDRESS:________________________________ PHONE:______________
RELATIONSHIP:________________________
DOCTORS NAME:____________________ PHONE NUMBER:____________
Do you have any known allergies?_________(If yes, please list)
1.___________________________ 2.___________________________
3.___________________________ 4.___________________________
What type of reaction do you experience to each? Please list:
1.___________________________ 2.___________________________
3.___________________________ 4.___________________________
When was your last tetanus shot?__________ Booster:__________
Are you diabetic?_____ If yes, what are your dietary requirements?
__________________________________________________________
Do you take insulin?_____ Type_______ Dosage_______ Times_______
or oral glycemic?________ Type_______ Dosage_______ Times_______
Are you hypoglycemic?_______ If yes, what are your dietary requirements?________________________________________________
PARTICIPANTS NAME:________________________________________
Are you epileptic?_______
Do you suffer from Dizziness_____ Fainting_____ Asthma_____
Blackouts_____ Respiratory problems_____ High blood pressure_____
Sickle Cell Anemia_____ Condition under medical care_____
If yes to any of the above please describe:__________________________
Please list each prescribed medication and dosage:
1.___________________________ 2.___________________________
3.___________________________ 4.___________________________
If your child uses an inhaler, do you want them to carry it and self-administer?
_________ or should it be kept in the health coordinators office?__________
PLEASE
CHECK ONE OF THE FOLLOWING:
May we dispense Aspirin _______ OR Tylenol_______
in addition to any of the applicants prescribed medication?
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I am willing for my son/daughter to attend Hammond Operation Snowball at
Gavit
High School, Hammond, IN. on October 26 - 29, 2000.
I hereby release Operation Snowball and its staff from responsibility for injury to
my child during the event. I also am giving my permission for my child to have a
group photo taken during the event. This photo will serve as a memento of the
Snowball Event.
In addition, I authorize the Operation Snowball staff health coordinator to give
permission for emergency medical treatment in the event I am unavailable.
I and my child have read the rules pertaining to Hammond Operation Snowball
and my son/daughter has agreed to follow the rules while at the event.
Parent Signature:______________________________ Date:______________
Participants Signature:__________________________ Date:______________ |
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