Spring Hill Elementary School Panther Press



Spring Hill Elementary School Panther Press
Spring Hill Elementary School
No. 64
Panther Press
June 8, 2016
Website: http://www.fcps.edu/SpringHillES/
Office Hours 7 a.m. until 4 p.m. Monday through Friday
Office Phone: (703)506-3400 Fax: (703)506-3497
Absent? Tardy? 24-hour attendance line at (703) 506-3434
6th Grade Graduation/Awards Ceremony
Wednesday, June 22, 2016
9:15 a.m. in the gym
NOTE: Doors to the gym will not open until 8:30a.m.
Yearbooks, class
6th GR Panorama
& Spring Photos
Class Parties
Food Orders
When placing food delivery orders for
class parties, please place the order in the
name of the classroom teacher so the
office can find you. We receive a large
number of delivery orders in the office on
class party days and any name other than
a classroom teacher will often not be
recognized. We don’t want your order to
get cold while we are trying to find you!
Pre-paid orders with tip included are
Students Not Returning to Spring Hill for the 2016-17 School Year
If your child will not be returning to Spring Hill in September and you will need documents to
take with you, please email Becky Abbott([email protected]) NOW. She will need
time to prepare the documents. Include in your request: Student’s name, grade, last day of
attendance and where he/she will be moving. A parent also needs to stop by the
office and complete a withdrawal form.
There is a $5 (cash only) fee for preparing the documents.
See Inside this Issue:
Page 1: Yearbooks & Photos, Class
Parties, Students not Returning to Spring
Page 2: Calendar, Yabe
Page 3: Kiss & Ride, Summer Hours, Fun
Fair Raffle Winners golfing w/Ms. Shaheen
Page 4: 5th Grade Tdap Reminder,
Page 5-7: Summer Reading
Page 8: Hoop Life Summer Camp
Page 9-12: Girl Scouts
Last Day of School:
Thursday, June 23rd
2 Hr Early Release (1:35)
Thank you everyone for supporting the Yabe, Japan
exchange program by purchasing popsicles for our
fundraiser! Popsicles will continue to be sold every
Monday and Friday in the cafeteria for $1 until the end
of the school year.
If you would like to support the Japan program in
another way, please visit and share our fundraising
page, www.gofundme.com/springhillyabe2016
Thank you!!
Time Out of School
Please schedule your family vacations during FCPS designated holidays / breaks,
which you can see at this link: http://www.fcps.edu/cal.shtml Be aware that missing
school for extended periods of time negatively impacts your child and your child's
Week of June 6th:
Wednesday, June 8th: Taste of Spring Hill, Cafeteria, 5:30-7:30 pm
Thursday, June 9th: Talent Show Dress Rehearsal K-3, Cafeteria, 4-6 pm
5th & 6th GR Orchestra Concert, Gym, 7-8:30 pm
Friday, June 10th: 5th & 6th GR Orchestra Concert, Gym, 9:15-10:15 am
K-3 Talent Show Performance, Cafeteria, 2-3 pm
Week of June 13th:
Monday, June 13th; Dolly Madison Library Summer Reading Program (All Grade Levels), Lg
Pod, 9 am –12:30 pm
Patrol Picnic, Black Top, 12-12:50 pm
6th Gr Battle of the Books, Lg Pod, 2-2:30 pm
Talent Show Dress Rehearsal GR 4th-6th,Cafeteria, 4-6 pm
Tuesday, June 14th: 5th & 6th Gr Principal Coffee, Lg Pod, 8:30-10 am
3rd Gr Kid’s Business Day, Field behind 3rd grade wing, 9-10:40 am
Talent Show Performance for 4th-6th Gr, Cafeteria, 2-3 pm
4th GR Orchestra Concert, Gym, 7-8:30 pm
Wednesday, June 15th: 3rd GR Strings & 4th GR Orchestra Concert, Gym,
9:15-10:15 am
Kindergarten EOY Party, Classrooms
Thursday, June 16th: Field Day
Friday, June 17th: Field Day (Rain Date)
2nd GR EOY Party, Classrooms,10 am-12 pm
1st GR EOY Party, Behind 3rd gr wing,10 am-12 pm
SHES Got Talent Show Performance, Cafeteria, 6:30-8 pm
Week of June 20th:
Monday, June 20th: 6th GR Civil War Museum, Gym, 9-11 am
3rd GR EOY Party, Upper Playground & Behind 3rd GR Wing, 9:30-11:30 am
Tuesday, June 21st: 6th GR Party, Outside & Gym, 9 am - 3:30 pm
Ferek & Fishbone Simple Machine’s Showcase, Cafeteria 9-10:30 am
Wednesday, June 22nd: Kindergarten Field Day/Party, Lower Field & Lg Pod
6th GR Graduation, Gym, 9-11 am
Thursday, June 23rd: Last Day of School, 2HR Early Release (1:20 pm)
4th GR EOY Party, Lower Field,
5th GR EOY Party, Behind 3rd GR Wing & Black Top
Field Day: Kiss & Ride
On Thursday, June 16 (Field Day), the Kiss and Ride area
will be closed from 8:40 AM until 3:10 PM as children will
be moving in and out of the Kiss and Ride area to
participate in Field Day activities on the lower field.
Summer Office Hours
Due to the replacement of air conditioning units this
summer, July 5th through July 29th, the office will have
limited open hours. We will attempt to be open from 8am to
12 noon. The office will be open only by appointment in the
afternoons. If we should need to be closed, we will leave a
message on our phone. Call 703-506-3400 to confirm
hours available.
Fun Fair Raffle Winners
Saturday morning was
fun golfing with
Connelly Roberge and
Nikki Hoffman.
Thanks girls.
Ms. Shaheen
This school newsletter will be issued every other Wednesday during the school year on
our website, under “News and Events.” You will receive an email link to the newsletter if
we have your current email address. Deadline for submissions are Mondays by Noon.
Email [email protected] Please include Panther Press in the subject.
5th Graders:
Don’t Forget to Get Your Tdap
All students in Virginia must receive a booster dose of Tdap
vaccine prior to entering the sixth grade.
Please bring your proof of immunizations to the office as soon
as possible.
If your child’s birthday falls prior to the end of school, please make
every effort to get the immunization and bring the documentation to
school by June 23rd.
If your child’s birthday falls after school is out, but by September
2nd you must bring documentation to the school by September 2nd,
or you child will not be allowed to start school September 6th.
If your child’s birthday falls after September 6th, you must bring
documentation from your child’s doctor stating the date
immunization will be given (should be on or soon after 11th
birthdate). This must be turned in by September 2nd or your child
will not be allowed to start school on September 6th.
Children who come to school on September 6th without the
proper documentation will be called to the office and parents
will be called to come and get them.
Book Your Summer!
We hope all Spring Hill Elementary School students will
Here are a few suggestions:
1. Print off the summer reading challenge bingo sheet to help make reading a fun challenge
this summer. Go to: fcps.edu/is/book/
Submit your completed READ! card online from June 27th until September 7th.
Students may submit more than one entry; however every participant has an equal
chance to win a prize. In every school, students at each grade level will be randomly
selected to receive $50 in books of their choice. A single student at each school will be
randomly selected to receive a laptop.
2. Fairfax County Public Library offers a summer reading program. Kids can register
online at: www.fairfaxcounty.gov/library/srp/ or visit a branch library beginning June 23rd.
All students can submit their reading logs at a branch library and receive a coupon book.
*The coupons feature items and activities such as discounts to: Six Flags, mini golf, frozen
yogurt, pizza, pottery painting as well as admission to some of the RECenters and nature
centers. The library offers lots of FREE fun events all summer long!
3. Participate in the Barnes & Noble Summer Reading Program.
Kids can earn a FREE book from a Barnes and Noble store! To get started,
either pick up a Reading Journal at the SHES library OR print one:
To earn a FREE book at Barnes and Noble:
* Record 3 books on the Make your Own Triathlon (PDF).
* Bring the completed Reading Journal to your local B&N store.
* Choose a FREE BOOK from the list featured on the journal...
4. Read the attached articles to encourage your child to read this summer.
Happy Reading!
Janis Lefcourt and Janet Hugger
Raising a Reader
How do you raise a child to be an enthusiastic and consistent reader? TV, videogames,
computers, and other modern distractions sometimes make it difficult for children to focus on
Here are some strategies that the diligent parent can use to help motivate a child to read. Try
them all -- what doesn't work one day may work well the next.
Visit your local library often. Get your children their own library cards. Try a story hour
or other free event at the library.
Check out the local bookstore. A book or gift certificate always makes a terrific gift.
Let your child see you reading, whether it's the newspaper, a magazine, or the latest
Encourage older children to read to their younger brothers and sisters. Or have the whole
family set aside some time to read together!
Show your child how people use reading all the time. Read aloud street and store signs,
maps, billboards, menus, and labels on packages.
Create a library for your child of new or used books. Look for affordable books at yard
sales, secondhand book stores, and library book sales.
Set up an area in your home where a variety of reading materials are within easy reach.
Encourage writing by including paper, crayons, pens and pencils.
Subscribe to a children's magazine. Read it with your child every month.
Carry books to read to your child wherever you go - at the doctor's office, in line at the
store, or on a long car ride. (You can also listen to stories on tape.)
Encourage a love of words by playing rhyming and word games, singing silly songs, or
writing poems and stories together.
Talk about daily activities or tell stories about your family or culture to help children
develop their language skills.
Visit the Between the Lions web site (pbskids.org/lions) for more on children and
Some more ways to Encourage Reading
1. Scout for things your children might like to read. Use their interests and hobbies as starting points.
2. Leave all sorts of reading materials including books, magazines, and colorful catalogs in conspicuous places
around your home.
3. Notice what attracts your children's attention, even if they only look at the pictures. Then build on that
interest; read a short selection aloud, or simply bring home more information on the same subject.
4. Let your children see you reading for pleasure in your spare time.
5. Present reading as an activity with a purpose—a way to gather useful information for, say, making paper
airplanes, identifying a doll or stamp in your child's collection, or planning a family trip.
6. Play games that are reading-related. Check your closet for spelling games played with letter tiles or dice, or
board games that require players to read spaces, cards, and directions.
7. Perhaps over dinner, while you're running errands, or in another informal setting, share your reactions to
things you read, and encourage your children to do likewise.
8. Read aloud to your child, especially a child who is discouraged by his or her own poor reading skills. The
pleasure of listening to you read, rather than struggling alone, may restore your child's initial enthusiasm for
books and reading.
9. Encourage your child to read aloud to you an exciting passage in a book, an interesting tidbit in the
newspaper, or a joke in a joke book. When children read aloud, don't feel they have to get every word right.
Even good readers skip or mispronounce words now and then.
10. On gift-giving occasions, give books and magazines based on your child's current interests.
11. Introduce the bookmark. Remind your youngster that you don't have to finish a book in one sitting; you can
stop after a few pages, or a chapter, and pick up where you left off at another time. Don't try to persuade your
child to finish a book he or she doesn't like. Recommend putting the book aside and trying another.
12. Treat your children to an evening of laughter and entertainment featuring books! Many children (parents,
too) regard reading as a serious activity. A joke book, a story told in riddles, or a funny passage read aloud can
reveal another side of reading.
13. Extend your child's positive reading experiences. For example, if your youngster enjoyed a book about
dinosaurs, follow up with a visit to a natural history museum.
14. Offer other special incentives to encourage your child's reading. Allow your youngster to stay up an extra 15
minutes to finish a chapter; promise to take your child to see a movie after he or she has finished the book on
which it was based; relieve your child of a regular chore to free up time for reading.
15. Limit your children's television viewing in an effort to make time for other activities, such as reading. But
never use TV as a reward for reading, or a punishment for not reading.
16. Not all reading takes place between the covers of a book. What about menus, road signs, food labels, and
sheet music? Take advantage of countless spur-of-the-moment opportunities for reading during the course of
your family's busy day.
Source: RIF Parent Guide Brochure.
Reserve A Space
For Only A
$40 Deposit
Hoop Life
Summer Basketball Camp
Does your child like basketball? Do you
want them to learn the game and have a
good time during their summer break?
Well, enroll them in the Hoop Life
Summer Basketball Camp.
Hoop Life is a premier basketball
training organization that trains players
ranging from beginners to professionals.
Our camps will raise your child’s
basketball skills and IQ in a fun, safe,
and competitive basketball environment.
All of our coaches have playing or
coaching experience on higher levels of
basketball including the NBA.
Areas of Focus
Individual Skills
• Passing
• Shooting
• Dribbling
• Defense
Team Skills
• Fast Breaks
• Pick n’ Roll
• Reading & Using Screens
• Help n’ Recovery
McLean, VA Location
Attendees: Boys & Girls
Ages: 4 to 14 years old
Dates: July 5-8; July 25-29
Time: 9am – 4pm
Where: Cooper Middle School
977 Balls Hill Road
McLean, VA 22101
$40 Non-refundable Deposit
$200 - $250 Early Registration (before 6/1)
$225 - $275 Normal Registration
*Register multiple children and save 10%
**Register as a team and save 20%
***Refer friends for split $50 discount
For more information: Call Coach Kevin
Harris @ 571-241-1486 or email him at
[email protected]
This camp is operated to battle against
childhood obesity and bullying. Help us
with the fight for healthy lifestyles!!!
Go to www.myhooplife.com to register online for any camp
Basketball Camp Registration Form
Head of Household (first/last name) _________________________________________________________________
Home Ph. __________________Work Ph. __________________Cell_________________
Email_________________________________________ Camper Name____________________________________
Gender M__ F__
Date of Birth__/__/__
Camper T-Shirt Size________
(Check All that Apply)
Session 1 (July 5 - 8):
*$40 Deposit ___
$200 Early Registration (before June 1st) __
$225 Normal Registration __
Session 1 (July 25 - 29): *$40 Deposit ___
$250 Early Registration (before June 1st) __
$275 Normal Registration __
Lunch: $30 Lunch (2 pizza slices & Gatorade daily) ____
**Multi-Family Discount available for 2nd & additional children
Register online at: www.myhooplife.com
***Must register at least 5 children at once
Some discounts cannot be combined
Total Enclosed $_________
Mail completed registration form with payment to: Hoop Life, Inc. P.O. Box 25672 Alexandria, VA 22313
Make Checks Payable to: Hoop Life, Inc.
Hold Harmless Agreement: In consideration of Hoop Life, conducting various programs and allowing the above to participate in such programs, the undersigned realizing the risk
of injury attendant to such programs, does hereby and forever discharge Hoop Life and its officers, agents, and employees from any and all action, claims or liability resulting from
or arising out of or based upon any bodily injury or property damage which may be sustained by the undersigned or the undersigned’s child while participating in such programs.
Signature required of adult participant, parent or guardian of child
____________________________________________________________________________________________________________________ Date____________________
These materials are neither sponsored nor endorsed by the Fairfax County School Board, the Superintendent, or this school.
Want to know what it’s like to be a Girl Scout? Join us at
Girl Scout Camp Try It
this summer
Disclaimer: These materials are neither sponsored nor endorsed by the County School Board, the Superintendent, or this school.
Camp Try It is a community-based camp designed for girls in grades
K-6 who are not currently enrolled in Girl Scouts. Activities include
arts and crafts, songs, games, STEM experiments, Girl Scout
traditions and so much more!
Camp Try It es un campamento de comunidad diurno
diseñado para las niñas que no son miembros actualmente de
las Girl Scouts que cursan los grados K-6. Las actividades
incluyen: artes, manualidades, canciones, juegos, ciencias,
tecnología, ingeniería, matemáticas, tradiciones de Girl Scouts y
mucho más.
Cost $50
Costo $50
To Register Online
Registracion en línea
To Register by Mail
Registracion por correo
For more information
Para más información
Financial Assistance Available
Includes: camp, t-shirt, snacks and bus
Fill out enclosed form and mail form and
check to:
Girl Scouts Nation’s Capital
Camp Try It
4301 Connecticut Ave, NW
Washington, DC 20008
Annette Rollins
[email protected]
Asistencia Financiera Disponible
Incluye: campamento, camiseta,
meriendas y el transporte en autobús
Enviar hoja y pago en cheque o giro a
nombre de:
Girl Scouts Nation’s Capital
Camp Try It
4301 Connecticut Ave, NW
Washington, DC 20008
Zoe Rodriguez
[email protected]
Volunteer opportunities!
We are looking to hire adult staff for camp to serve as Camp Directors, Unit
Leaders and First Aiders. If you or someone you know is interested, please
complete the application at:
Teens in grades 7-12 that are looking to earn Student Service Learning
Hours can apply to volunteer at:
Make sure you keep this page for the contact information!
Camp Name
Bus Stops
Camp Try It - St. Mary’s
June 15-17
St. Mary’s County Fairgrounds
42455 Fairgrounds Rd.
Leonardtown, MD 20650
Charlotte Hall Library, Chaptico Market, Benjamin Banneker ES, Lexington Park
ES, Wildewood Shopping Center and Doresy Park
Camp Try It - Loudoun
June 20-24
Algonkian Regional Park
47001 Fairway Dr.
Sterling, VA 20165
Meadowland ES, Sugarland ES, Sterling Community Center, Dulles South
Multipurpose Center, Pinebrook ES, Legacy ES and Broad Run ES
Camp Try It - Manassas
June 20-24
Nokesville Park
12560 Aden Rd.
Nokesville, VA 20181
Yorkshire ES, Cougar ES, Round ES, Marsteller MS, Weems ES, West Gate ES and
Sinclair ES
Camp Try It - Brookeville
June 20-24
Camp Brighton Woods
120 Brighton Dam Rd.
Brookesville, MD 20862
Cloverly ES, Greencastle ES, Cannon Road ES, Kemp Mill ES, Glenallen ES, Olney
ES, Rock Creek Terrace Apartments and Wheaton Woods ES
Camp Try It - La Plata
June 20-24
Grace Lutheran Church & School
1200 Charles St.
La Plata, MD
Smallwood MS, Pisgah Park, McDonough HS, Berry ES, Wade ES and Thomas
Stone ES
Camp Try It - DC
June 20-24
H.D. Cooke Elementary School
2525 17th St. NW
Washington, DC 20009
Shepherd ES, Bancroft ES, Mann ES and Garrison ES
Camp Try It - Urbana
June 27-30
Green Meadow Farm
10102 Fingerboard Rd.
Ijamsville, MD 21754
Middletown Primary, Waverly ES, North Frederick ES, Urbana Library, Whittier ES,
Monocacy ES, Liberty ES, New Market ES and Kemptown ES
Camp Try It - Braddock
June 27-July 1 Braddock Elementary School
7825 Heritage Dr.
Annandale, VA 22003
Woodson HS, Little Run ES, Bren Mar ES, Weyanoke ES, Pine Spring ES, Glen
Forest ES and Mason Crest ES
Camp Try It - Leesburg
June 27-July 1 Leesburg Elementary School
323 Plaza St. NE
Leesbrug, VA 20176
Lovettsville ES, Lucketts ES, Balls Bluff ES, Round Hill ES, Harmony ES and
Evergree Mill ES
Camp Try It - Oxon Hill
June 27-July 1 Oxon Hill High School
6701 Leyte Dr.
Oxon Hill, MD 20745
Giant Food Livingston Rd., Rosaryville ES, Kettering ES, Samuel P. Massie
Academy, District Heights ES, Suitland ES, Francis T. Evans ES and Brandywine ES
Camp Try It - Rockville
July 5-8
Katherine Thomas School
9975 Medical Center Dr.
Rockville, MD 20850
Germantown ES, Rachel Carson ES, Bethesda ES and Meadow Hall ES
Camp Try It - St. Leonard
July 11-15
Crossroads Christian Church
150 Ball Rd.
St. Leonard, MD 20685
Rolands Grocery Store, Huntingtown HS and Prince Frederick Safeway
Camp Try It - Stafford
July 11-15
Camp Coles Trip
134 Payne Ln.
Stafford, VA 22554
Occoquan ES, Leesylvania ES, Mary Williams ES, Penn ES, Minnieville ES, Fannie
Fitzgerald ES, Montclair ES, and Dumfries ES
Camp Try It - Oakton
July 11-15
Camp Crowell
10900 Vale Rd.
Oakton, VA 22124
Franklin Sherman ES, Churchill Road ES, Hutchison ES, Deer Park ES,
Greenbrier West ES, Mosby Woods ES, Eagle View ES, Timberlane ES, Freedom
Hill ES, Springfield Estate ES, Forestdale ES, Lynbrook ES, Crestwood ES, Hagel
Circle and Laurel Hill ES
Camp Try It - Takoma Park
July 11-15
Takoma Park Elementary School
7511 Holly Ave.
Takoma Park, MD 20912
Burnt Mills ES, Cresthaven ES, JoAnn Leleck ES, Viers Mill ES, Rock View ES,
Oakland Terrace ES, Woodmoor Shopping Center, Silver Spring Library,
Rosemary Hills ES, New Hampshire Estates ES, Long Branch Library and East
Silver Spring ES
Camp Try It - Aquasco
July 18-22
Camp Aquasco
17100 Aquasco Farm Rd.
Aquasco, MD 20608
Riverdale ES, Chuck E Cheese at Capital Blvd., Benjamin Tasker MS, Kenmoor MS,
Shopper’s Food Warehouse New Carrollton, Bladensburg HS and Theresa Banks
Camp Try It - Haymarket
July 18-22
Battlefield High School
15000 Graduation Dr.
Haymarket, VA 20169
Liberty HS, Taylor MS, Marshall Community Center, P.B. Smith ES, Glenkirk ES and
Haymarket ES
Camp Try It - Alexandria
July 25-29
Del Ray United Methodist Church
100 East Windsor Ave.
Alexandria, VA 22301
Rose Hill ES, Mt. Eagle ES, Cameron ES, Whitman MS, Woodlawn ES, Mt. Vernon
Woods ES, Ft. Belvoir ES, Woodley Hills ES, Riverside ES, Groveton ES, Hybla
Valley ES and Hollin Meadows ES
Camp Try It - Frederick
July 25-29
Trinity United Methodist Church
703 W Patrick St.
Frederick, MD 21701
Thurmont Primary, Walkersville ES, Hillcrest ES, Ballenger ES, Orchard Grove ES,
Deer Crossing ES, Spring Ridge ES and Lincoln ES
KEY: ES - Elementary School • MS - Middle School • HS - High School
Write Your Camp Location Choice/ Escriba el Campamento que seleccionó
□ New Girl Scout/Registración Nueva Girl Scout □ Registered Girl Scout/Girl Scout Registrada Troop#/Tropa #__________
Last Name/Apellido
Date of Birth/Fecha de Nacimiento
Apartment/ Apartamento
Zip Code/Código Postal
Mother/Father/Guardian 1/ Padre/ Madre/Guardian 1
Mother/Father/Guardian 2/ Padre/ Madre/Guardian 2
Work Phone/Teléfono del Trabajo
This program offers transportation free of
charge to all participants./ Este programa
ofrece transportación gratis a todas las
Home Phone/Teléfono de la Casa
Custody/Custodia: □ Both Parents/Ambos Padres □ Mother/Guardian/Madre/Guardian □ Padre/Guardian □ Other/Otro (especificar)
Emergency Contact Information other than those listed above. By including names and contact information below, I authorize the Camp Director to call these
individuals in the event a parent/guardian cannot be reached. I also authorize my child to be released to these individuals./ Contacto de Emergencia personas distintas
de las enumeradas anteriormente. Con la inclusión de los nombres e información de contacto más abajo, autorizo al Director del Campamento llamar a estos individuos
en el caso de que un padre / tutor no puede ser localizado. También autorizo a que mi hija sea entregada a estas personas.
Emergency Contact #1/Contacto de Emergencia #1
Emergency Contact #2/Contacto de Emergencia #2
Please use the space below to list any additional people, beyond those already listed, who are authorized to pick up your daughter.
Utilice el siguiente espacio para enumerar personas adicionales, más allá de las ya enumeradas, que están autorizados a recoger a su hija.
Girl Scouts respects and welcomes people from all backgrounds and abilities. By completing the following information (as defined by the US census), you ensure
support and funding for girls in your community. Hispanic/Latina is defined as an ethnicity by the US census, not a race, therefore is reported separately./ Girl Scouts
respeta y acoge con satisfacción personas de todos los orígenes y condiciones. Al completar la siguiente información (tal como se define por el Censo de Estados
Unidos), se asegura el apoyo y el financiamiento de las niñas en su comunidad. Hispano / Latino se define como un grupo étnico en el Censo de Estados Unidos, no es
una raza, por lo que se informa por separado.
□ American Indian or Alaskan Native / India Americana o Nativa de Alaska
□ Asian/ Asiática
□ Black or African American/ Negra o Afroamericana
□ Hawaiian or Pacific Islander / Hawaina o de las Islas del Pacífico
□ White/ Blanca
□ Other (Please specify)/ Otra (Favor de especificar)
□ I choose not to share at this time / Decido no compartir la información en
éste momento.
She is Hispanic
or Latina:/ Ella
es Hispana o
Name of School/Nombre de la Escuela
□ Yes/Si
□ No
□ I choose not to
share at this time /
Decido no compartir
la información en
éste momento.
School City/Ciudad
School State/Estado
Current Grade in School/Grado Escolar de la Niña
Health History/ Historial Médico
Is an Epi-Pen Required?¿Inyección e Epinefrina es necesaria?
□ No
Home Phone/Teléfono de la Casa
Email/Correo electrónico
She is:(Check all that apply)/ Ella es: (Marcar todas las que apliquen)
The Girl Scout Council of the Nation’s
Capital and the Girl Scouts of the USA
(GSUSA) may use photographs in which
my child appears to promote Girl
Scouting./ El Concilio de Girl Scouts de la
Capital de la Nación y las Girl Scouts de
los E.U. (GSUSA) podrá utilizar
fotografías en las que mi hija parece
promover las Girl Scouts.
□ Yes/Si
Email/Correo electrónico
Work Phone/Teléfono del Trabajo
□ Teen/Adolescente
Do you need bus transportation?/ ¿Su
hija necesita transportación?
□ Yes/Si
□ No
Please Write your bus stop:/Escribe la
parada del bus:
The Program registration fees are
$50.The fees are non-refundable./
El costo de este programa es de $50. El
costo no es reembolsable.
The Girl Scout Council of the Nation’s Capital
offers financial assistance to make camp
available to all girls grades K-12. Please
remember that we want to offer financial
assistance to as many girls as possible, so
only request what your family truly needs./
El Concilio de Girl Scouts de la Capital de la
Nación ofrece asistencia económica para
niñas en los grados K-12. Por favor, recuerde
que nosotros queremos ofrecer asistencia a
tantas niñas como sea posible, por lo que
sólo pida lo que realmente necesita su
My family requests the following
amount in financial assistance toward
the registration fee:/
Mi familia solicita la siguiente cantidad
de asistencia económica hacia el costo
de inscripción:
□ Yes/Si □ No
Allergies (Please list all)/ Alergias (Favor nombrar todas)
Please specify any accommodations that are needed/ Favor indicar la necesidad de algún acomodo razonable
Health Concerns/ Condiciones de Salud
Operations or Serious Injuries/ Cirugías o Lesiones Graves
□ Emotional/Emocional
□ Learning/Aprendizaje
□ Physical/Física
□ Visual
Please specify any accommodations that are
needed/ Favor indicar la necesidad de algún
acomodo razonable
□ Deaf/Hard of Hearing/ Sordo/Mudo o Dificultad
para escuchar
□ Behavioral/ Comportamiento
□ Not Applicable/ No Aplica
□ Other (Please Specify)/ Otra (favor de
Medication Information/Historial Médico:
Will your daughter be bringing medication to camp/ ¿Su hija traerá medicamentos al Campamento?
□Yes/ Si
□ No
□ Epi-Pen/ Inyección de Epinefrina
□ Insulin/Insulina
□ Inhaler/Inhalador
□ Over the Counter/ Medicamentos No Recetados_______________ □ Prescription/ Medicamentos Recetados_____________
Is your daughter enrolled in a public, private or public charter school?/ ¿Su hija
Are all
If immunizations are not up to date, is a state certificate
esta matriculada en una escuela pública, privada o charter?
immunizations up
from the physician or parent stating medical or religious
□ Yes/ Si
to date:/
reasons on file with the school?/
□ No
Todas las
Si las vacunas no están al día, necesita presentar como
evidencia certificado del estado por parte del médico o de
vacunas están al
Home School campers must submit additional health documentation / Niñas que
los padres indicando razones médicas o religiosas.
participan de Escuela en el Hogar deben presentar documentación adicional de
□ Si
□ Yes/ Si
□ No
□ No
Family Physician/Médico de Familia
Health Insurance/Seguro Médico
Mail To: Girl Scouts Nation’s Capital, Attn: Camp Try It, 4301 Connecticut Ave, NW, Washington, DC 20008
Policy #/ Número de Póliza
The information and health history is correct so far
as I know, and the person herein described has
my permission to participate in all prescribed
activities as noted. If she/he appears to be ill, I will
not send her/him to the program. I understand my
daughter will become a registered member of the
Girl Scouts of the USA through participation in this
program. I hereby give permission to the medical
personnel selected by the camp director or her/his
designee to order x-rays, routine tests and
treatment for my child. In the event I cannot be
reached in an emergency, I hereby give
permission to the physician selected by the camp
director, or her/his designee, to hospitalize, secure
proper treatment for, and/or injection, and/or
anesthesia, and/or surgery for my child as named
above. / La información de salud es correcta hasta
donde yo sé, y la persona aquí descrita tiene mi
permiso para participar en todas las actividades
prescritas como se ha señalado. Si ella parece
estar enferma, no voy a enviarla al programa.
Entiendo que mi hija se convertirá en un miembro
registrado de las Girl Scouts de los EE.UU. a
través de la participación en este programa. Por la
presente autorizo al personal médico seleccionado
por el director del campamento o su designado
para ordenar radiografías, exámenes de rutina y
tratamiento para mi hijo. En el caso de que yo no
pueda ser localizado en caso de emergencia, doy
permiso al médico seleccionado por el director del
campamento, ella / él designe, para hospitalizar,
asegurar el tratamiento apropiado, y / o inyección,
y / o anestesia y / o cirugía para mi niña nombrada
Parent/Guardian Signature and Name/
Firma y Nombre de Padre/Madre/Guardian