Madison Junior School - Madison Public Schools

Transcripción

Madison Junior School
160 Main Street
Madison, New Jersey 07940
Phone: 973-593-3149
Nicole Sherrin, Principal
David Coster, Assistant Principal
Fax: 973-966-1908
August 2014
Dear MJS Parent:
This packet contains a great deal of material to digest. Much of it must be returned with
your child on the first day of school. We have constructed the following check-off list to make
your life easier! Please complete the following and have your child bring them to ADVISORY
on Thursday, September 4, 2013. There are a total of thirty-three items on this checklist.
_______________1. Ms. Sherrin’s Welcome Back Letter (Please Read)
Mandatory Forms (Return the first day of school)
_______________2. Emergency Card (Mandatory)
_______________3. MJS Student Directory Form (Mandatory)
_______________4. Web Site Parental/Guardian Consent Form (Mandatory)
_______________5. Internet Contract Form (Mandatory – 3 pages)
_______________6. Google Account Permission Slip (Mandatory)
_______________7. Local Field Trip Permission Slip (Mandatory-2 pages)
_______________8. Health Office Letter (Mandatory)
_______________9. Health Evaluation Form (Mandatory)
______________10. Immunizations Form (6th Grade Only-Mandatory)
______________11. Name Verification Form (8th Grade only-Mandatory)
Additional Health Forms
______________12. Food Allergy Action Plan (If applicable – 2 pages)
______________13. Asthma Treatment Plan (If applicable – 2 pages)
______________14. Medical Request & Permission Forms (If applicable)
______________15. Student Accident Insurance Information (Optional)
______________16. Sudden Cardiac Death Information (Please Read)
______________17. MJS Food Guidelines (Please Read)
Additional Informational/Membership Forms
______________18. Honeywell Instant Alert Information (Optional)
______________19. School E-Alerts Information (Optional-2 pages)
______________20. Parent Resource Form (Optional)
______________21. MJS PTO Dues Form (Optional)
______________22. MJS PTO Volunteer Opportunities Form (Optional)
______________23. MJS PTO A+ School Rewards Program (Optional)
______________24. MJS PTO JETS Fundraiser (Optional)
______________25. Madison Music Association Dues and Volunteer Forms
(Optional-2 pages)
______________26. Madison Young Playwrights Application Form (Optional-2
pages)
______________27. PPEC Membership Form (Optional – 3 pages)
______________28. Madison Schools Lunch Program (Optional)
______________29. Information on Free & Reduced Lunch Program (If
applicable)
______________30. District Calendar (Please Keep)
______________31. MJS Calendar (Please Keep)
______________32. MJS Bell Schedules (Please Keep-2 pages)
______________33. Report Card Schedule (Please Keep)
Thank you for investing the time to complete these forms.
Sincerely,
Nicole Sherrin
Principal
160 Main Street
Phone: 973-593-3149
Fax: 973-966-1908
August 19, 2014
Dear MJS Students and Parents:
We hope this summer has been fun, relaxing and invigorating. We are gearing up for a great school year.
Thank you for taking the time to review this letter and the lengthy packet.
To our new families – welcome! You are going to love MJS and we cannot wait to get to know you. Your
children will thrive during their time at the Junior School and have many supports in place to help make
their transition as smooth as possible. Please do not hesitate to reach out with any questions or concerns.
To our returning families – welcome back! We are confident that this will be the best year ever at MJS. As
always, we are finding ways to make a wonderful school even better.
The spring and summer have been busy with new hires, and we are thrilled to introduce twelve new faculty
members to the MJS team. They bring with them talent, experience and an enthusiasm for education. The
seventh grade is welcoming two new teachers – Amanda Solomon in mathematics and Barbara Zabel in
science. Ms. Solomon is a Rutgers grad who brings to us three years of sixth grade math teaching
experience as well as a zest for international travel. Ms. Zabel joins us after teaching seventh grade science
for the past seven years in New Brunswick. She was her school’s 2014 Teacher of the Year and was
instrumental in bringing a number of programs into the school. The math team has another new hire in
Peter Boveé. Mr. Bovee is joining us after two years of teaching 8th grade math in Roselle as well as
experience working with special needs students at Celebrate the Children. Certainly having a Mr. Bovee and
a Mr. Bovery in 8th grade math will bring us great amusement (or confusion). Finally, the Music Department
welcomes Matthew Rossi who will be teaching band lessons two days/week at MJS. Mr. Rossi is a recent
graduate from The College of New Jersey and recently completed a full year instrumental music maternity
leave in the Parsippany-Troy Hills school district.
The special education team is pleased to announce eight new faculty members. Ellen Sternberg is going to
be taking the helm of our LLD program. She served in two different positions as an LLD teacher in the
Flemington-Raritan school district and will certainly be an asset as we bring in this program. We
successfully ‘stole’ two excellent special education teachers from other schools – Susan Nering and Rich
Vasquez. You may recall Ms. Nering’s time at MJS at the end of the year when she did a brief (and highly
successful) leave position for us replacing Ms. Kolinchak. Prior to that she served two years as a teaching
assistant (TA) at TJS and she actively volunteers outside of school. Mr. Vasquez spent the last year as a TA
at MHS and also served as their boys’ soccer coach. He has experience teaching Spanish and is a history
enthusiast. We are also pleased to welcome four new TAs. Michael Bruner is a graduate from Rutgers
University. Mr. Bruner has been a basketball coach the past several years, most recently the head coach at
Columbia Middle School in Berkley Heights. Megan Crilley is a recent graduate from Kean University
with a B.A. in Education. Ms. Crilley has been very busy the last few months between graduating college
and then getting married in May, and setting up her new home in Westfield with her husband Paul. Darcey
Gohring comes to Madison Junior School from the world of Journalism where she worked as an editor on
magazines such as New Jersey Countryside, New Jersey Monthly and a copywriter for J.Crew clothing
catalog. Laura Cluff is joining us after working as a TA in both Harding and most recently at KRS. Her
experience with the self-contained classroom at KRS will certainly be valuable. Last, but certainly not least,
I would like to welcome our new case manager Catherine Steege. Ms. Steege has social work experience
with adolescents, having spent the past three years at the High Focus Centers providing individual and
family counseling to patients with both mental and substance abuse issues. She also served as a case
manager for SERVE Behavioral Health System, and we are sure her fluency in Spanish will be an asset to
the team.
Congratulations to Catie Young (nee Aery) on her marriage! I’d also like to welcome back Maryana
Kolinchak from her maternity leave. Best wishes as well to Lauren Cavallo who recently resigned
following her move down south – we are in the process of filling her position.
We would like to take a moment to thank our fabulous Head Custodian, Steve Cosmen, and his team for
an exceptional job getting the school ready. The heat was often unbearable and resources were scarce, so
their willingness to go above and beyond is truly appreciated.
The teachers’ websites will provide additional biographical information once the year gets underway. In
addition, you will have the opportunity to meet and learn more about each of your child’s teachers at Back
to School Night on Tuesday, September 16th.
Our academic teams for this year are:
Teams
Language
Arts
Math
Social
Studies
Science
6A
*Michelle
Brennan
Stefania
Lambusta
Richard
Bradshaw
Patrice
Donnelly
6B
Elizabeth
Rosica
Kelly
Bosworth
Stephen
Finkelstein
*Nancy
Hill
7A
Paige
Henry
Amanda
Solomon
Erik Lih
*Kate
Russo
7B
*Lisa Toto
8A
*Caitlin
Young
Anna
Peter
Hatziemanuel Bovee
Rich
Matt
Newbery
Millichap
Barbara
Monica
Zabel
Brady
8B
Danielle
Mack
Jim Bovery
*John
Ciferni
Catherine
Tahlmore
* Denotes Team Leader
As I have mentioned in the past, I craft the teams with my own children in mind. I would be thrilled to
have them on each and every one of these teams with this amazing group of people. Students will receive
their team assignments and schedules on the first day of school.
Something new on the schedule this year is our first ever Sixth Grade Boot Camp. Thank you to our Sixth
Grade Team Leaders, Michelle Brennan and Janice Corte, for spearheading this effort. We have invited
the sixth graders in the afternoon before school starts to get a ‘crash course’ in lockers, scheduling, as well as
an opportunity to meet the other students and their teachers. We are grateful to the PTO for sponsoring
this event.
Thank you to everyone who completed our TransOptions drop-off and pick-up survey last year. Over 60%
of respondents expressed an interest in additional “drop and go” locations. In an effort to be responsive to
this we have been partnering with Patrolman Rybka from the Madison Police Department and are pleased
to announce that the Police Department will be adding a crossing guard at Brittin Street and Alexander
Avenue and designating two areas for parents to “drop and go”.
Brittin Street at Dodge Field and Chapel Street (on the other side of Dodge Field) will be available for dropoff in addition to the already designated area behind MJS which can still be used. If you choose to utilize
Brittin Street and Chapel Street, please drop-off on the Dodge Field sides of the roadway and your child will
have crossing guards at every intersection leading to MJS. Brittin Street will also have signs prohibiting
parking for more than four hours at a time.
Additionally, the Madison Police Department has successfully petitioned the State of New Jersey to reduce
the speed limit in front of MJS when children are present to 25 miles per hour. We are incredibly grateful
for their support and we believe all of these steps will ensure the safety of the students, decrease emissions
created by idling cars and make drop-off more convenient for parents.
Map of Additional Drop-off Locations for MJS
CAS
Dodge
Field
MJS
Current Drop-off Location – Along the Athletic Field on Brittin Street behind MJS
Additional Drop-off Locations – Along Dodge Field on both Chapel and Brittin Streets
Crossing Guard Locations
Students – I hope you are looking forward to the year ahead. Sixth graders (and new seventh and eighth
graders), we are eagerly awaiting your arrival and have a lot of exciting things planned for you. While it is
normal to be nervous, there is so much in place to make the start of school as easy as possible. You will
have access to tours the morning of the 28th of August, during “boot camp” for 6th graders and on the first
day of school. We will work with you to make sure you understand your schedule, lockers, etc. Seventh and
eighth graders, we will be counting on you to serve as positive role models and to assist the sixth graders
and all new students. To all students, remember that there are many people here to assist you. Your
teachers all care about your success and are here for you, as are your guidance counselors, advisor, school
nurse, and office staff. Do not hesitate to ask for help if you need it!
Parents AND students - I look forward to working together throughout the school year to continue our
tradition of excellence at MJS.
Best wishes for a wonderful end to the summer and for the best school year ever. I know we have
everything in place to provide the students of Madison with an exceptional education. It’s going to be a
great school year and I look forward to seeing you all on September 4th!
Sincerely,
Nicole Sherrin
Principal
IMPORTANT INFORMATION REGARDING THE FIRST DAY OF SCHOOL:
September 4th is right around the corner, and we are looking forward to the great year ahead at MJS. Below
is some important information for the beginning of school.
ARRIVAL TIMES FOR OPENING DAY
6th Graders and New 7th and 8th Graders
7:50 am: Doors open for students. All new students will report to the auditorium for orientation.
Schedules will be distributed. Students will then proceed to their advisory where they will obtain their
locker assignments, agenda pads, supplies, etc. Schedules will be reviewed in detail in order to ensure
everyone’s comfort level. School expectations will be discussed, students will learn to operate their locks,
and they will receive a tour.
Once again, we will have Student Council students on hand to assist with schedules and finding classrooms.
In addition, the 8th grade Peer Leaders will be assisting the 6th grade advisories. We know they will help
ensure a smooth transition for our incoming students.
Returning 7th and 8th Graders:
Please arrive by 8:50am. At 8:55am, students will report to the auditorium. Returning students who ride the
bus to school will report to the cafeteria until 8:55am. Orientation will follow and schedules will be
distributed. Students will then report to advisory.
At 11:00am, all students will follow an abbreviated Thursday (A day) schedule. All classes, including lunch,
will be held.
Dismissal for all grades will be at the normal dismissal time – 2:43pm.
OTHER IMPORTANT INFORMATION:
Absent and/or Tardy
The MJS Roll Call number is (973) 593-3149 ext. 3151. A parent or guardian must call this number by
8:00am if a student will be absent or late. Students are not permitted to call in themselves. In order to
avoid missing instructional time, students must be in class by 7:55am. Period 1 instruction begins on time
(there is no homeroom). Tardiness after the first warning bell will result in a detention (unless a note with a
valid excuse is presented upon arrival).
Back to School Night
All parents/guardians are strongly encouraged to attend MJS Back-to-School-Night on Tuesday, September
16th at 7:00 pm in order to meet their child’s teachers, review the courses of study, and learn about
classroom practices such as student assessment. The teachers’ websites will provide additional background
about our staff and classroom procedures once the school year begins.
Backpacks
In an effort to be conscious of our students’ health and safety, please note that students will not be
permitted to carry backpacks between classes again this year. Students will have ample time to visit their
lockers in the morning and during the course of the day.
Communications
Please remember to sign up for E-Alerts and check the MJS website during the course of the year. We will
also be relying on the MJS News blasts to convey important information, updates on what is going on in the
classrooms, and other exciting news. Please make sure we have an accurate email address.
Important reminder - please customize the method you wish to use to be notified in the event of a snow
closing or school district emergency. Notifications are made through the Honeywell Instant Messaging
System, and can be received as phone calls, text messages, or emails. To designate your preferred numbers
and modes of communication, go to the district home page and click on the “Honeywell Instant Alert
System” tab.
Regarding emails: Due to our spam filtering system, parent emails may sometimes get caught in the filter
and not get through to us. If you do not hear back within 24 hours, please call the school at (973) 593-3149
and leave a message.
Delayed Opening and Planning for Emergency Closings
When we have a 2-hour delayed opening in the event of inclement weather – MJS doors will open at 9:50am
and classes will begin at 9:55am. In addition, please develop a plan your child can follow in the event of an
emergency closing. Information regarding emergency closings can be found in the district calendar provided
by the Board of Education.
Extra Help Period/Homework Club
Our teachers have an extra help period every day from 2:45-3:15pm. Additionally, the library is open for
homework club until 4:00pm on Tuesdays and Thursdays.
Musical Instruments
Musical instruments are not required the first day of school. Musical instruments should be brought to
school for the student’s second class (will depend on their schedule).
Physical Education
PE clothes and sneakers are not required on the first day. Students will need to bring their clothes - shirts,
shorts, socks and sneakers beginning on their second class (will depend on their schedule).
Picture Day
Our MJS Picture Day is scheduled for Wednesday, September 11th. Students will be receiving their order forms
on the first day of school. Please complete, and have students return the order form on Picture Day.
School Supplies
Supply lists for all three grades are available on the MJS home page. If supplies were ordered from the
PTO, they will be distributed on the first day of school. All students will receive an agenda/assignment pad.
Parents are urged to review the agenda pads with their child, as there is detailed information about MJS for
both parents and students.
School Tours
This summer, we are again offering the opportunity to become more familiar with our building to any
incoming 6th grader or new student. Our Student Council will be available to provide tours of the school in
order to ease the transition. Tours will be held every 30 minutes on Thursday, August 29th, from 9:00am11:00am. If you are interested in a tour, please come to MJS and sign in at the desk in the main hallway.
There will also be tours given to all new students on the first day of school.
Student Drop-off and Pick-up: Please see above regarding expansion of our drop-off and pick-up areas.
We will continue to encourage our students to bike or walk, when feasible, and encourage you, our parents,
to carpool whenever possible.
Safety is our primary concern. We urge you to be respectful of the crossing guards, administrators, and
faculty who are maintaining safety in and around the school property. For the safety and protection of our
students, you will not be allowed to drop off or pick up your child in the MJS parking lot from 7:30-8:00am
or from 2:40-3:10pm. Thank you for your cooperation.
Please be advised that teachers are only on duty outside supervising student arrivals in the morning
beginning at 7:45am and, in the afternoon supervising student dismissal, until 3:00pm.
MARK YOUR CALENDARS!
Student Tours
Thursday, August 28th – 9:00am – 11:00am
6th Grade “Boot Camp”
Wednesday, September 3rd – 1:00pm
Tuesday, September 16th – 7:00pm
Coffee with the MJS Administration
Friday, October 10th – 9:30am
6th Grade Family Night
Thursday, November 20th – 7:00pm
th
Please join us with your 6 grader for a special evening of sharing, activities, discussion, reflection, and
refreshments. During this event, you will hear from Madison Junior School students about the value of
their experiences with Advisory and Peer Connections. You will also be active participants in two Advisory
activities focused on the importance of relationships and issues that matter to adolescents and their families.
MADISON PUBLIC SCHOOLS STUDENT EMERGENCY CARD
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PLEASE PRINT
School : _______________________________________________
Grade/Teacher: ________________
Student Name: _______________________________________________
Last
First
Home Address: ______________________________________________
Birthdate: ______________________
Parent/Guardian 1 Name: _________________________________
Relationship: _____________________
Home Phone: __________________
Phone #s: Home (___) ___________Cell(___)___________Work(___)___________Email: ____________________
Parent/Guardian 2 Name: _________________________________
Relationship: _____________________
Parent/Guardian 2 Address (if different than above): ________________________________________________
□ Please check this box if there has been a name change of parent/guardian, address or phone number.
List two neighbors or nearby relatives who will assume temporary care of your child(ren) if you cannot be reached
Neighbor/Relative 1 Name: _________________________________ Address: _______________________________
Neighbor/Relative 2 Name: _________________________________ Address: _______________________________
For Information ONLY:
Allergies: ____________________________________________
Is Epipen prescribed? ____Yes
____ No
Physician: ___________________________________________
Tel. No: _______________________________
Dentist: _____________________________________________
Tel. No: _______________________________
Does this child have any health insurance including NJ FamilyCare/Medicaid, Medicare, private or other?
□ NO My child does not have health insurance. You may release my name and address to the NJ FamilyCare
Program to contact me about health insurance.
Signature: _________________________ Printed Name: _______________________ Date: ______________
Written consent required pursuant to 20 U.S.C. § 1232g(b)(1) and 34 C.F.R. 99.30(b).
NJ FamilyCare provides free or low cost health insurance for uninsured children and certain low income parents. For more information visit
www.njfamilycare.org to apply online or call 1-800-701-0710.
□ YES My child has health insurance.
Permission is given for my child’s picture and/or name to be used in the media: _____ No ____ Picture only _____ Name Only
____Name/Picture
STUDENT HEALTH SERVICES
I, the undersigned, do hereby authorize officials of New Jersey Public Schools to contact directly the person(s) named on this card and do authorize the named
physicians to render such treatment as may be deemed necessary in an emergency, for the health of said child. In the event that physicians, other persons named
on this card, or parents/guardians cannot be contacted, the school officials are hereby authorized to take whatever action is deemed necessary in their judgment,
for the health of the aforesaid child. I will not hold the school district financially responsible for the emergency care and/or transportation for said child. If,
under exceptional circumstances, a child is required to take medication during school hours and the parent cannot be at the school to administer the medication,
only the school nurse will administer the medication in compliance with Board Policy 5330 (Administering Medication).
Date: ______________
Parent(s) Guardian(s) Signature ___________________________________________
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MADISON PUBLIC SCHOOLS TARJETA DE EMERGENCIA DEL ESTUDIANTE
LETRA DE IMPRENTA
Escuela : ____________________________________
Grado / Maestra: __________________________
Nombre del estudiante: ________________________________
Fecha de Nacimiento: _________
Apellido
Nombre
Domicilio : ______________________________________ Teléfono del hogar: __________________
Padre / Tutor 1 Nombre: _____________________________Relación: _____________________
Teléfono #s :Hogar ( ___) _________ Celular ( ___) ________Trabajo( ___) ________Email : _______
Padre / Tutor 2 Nombre: _______________________________Relación: _____________________
Teléfono # s : Hogar ( ___) _______ Celular ( ___) _______Trabajo ( ___) _______Email : _____________
□ Marque esta casilla si ha habido un cambio de nombre de los padres / tutores , dirección o número de teléfono.
Dos vecinos/parientes cercanos que asumirán el cuidado temporal de su hijo/a si Ud. no puede ser localizado
Vecino / pariente 1 Nombre: ________________________ Dirección: ______________________________
Teléfono # s :Hogar ( ___) _______ Celular ( ___) _______Trabajo ( ___) _____Email : _______________
Vecino / pariente 2 Nombre: _________________________ Dirección: _____________________________
Teléfono # s :Hogar ( ___) ________ Celular ( ___) _______Trabajo ( ___) ________Email : ____________
Información Médica
Alergias: _______________________________________ ¿Se prescribe Epipen ? ____Sí ____ No
Médico: ___________________________________ Teléfono_______________________________
Dentista: __________________________________ Teléfono _______________________________
¿Tiene este niño seguro médico incluyendo NJ FamilyCare / Medicaid, Medicare, privado u otro ?
□ NO Mi hijo no tiene seguro de salud. Usted puede dar mi nombre y dirección a FamilyCare NJ
Programa de ponerse en contacto conmigo acerca de los seguros de salud.
Firma: _____________________Nombre Impreso : _______________________ Fecha: ______________
El consentimiento por escrito requerido de conformidad con 20 U.S.C. § 1232g( b )( 1 ) y 34 C.F.R. 99.30 ( b ).
NJ FamilyCare ofrece seguro médico gratuito o bajo costo para niños sin seguro médico y algunos padres de bajos ingresos. Para más información visite
www.njfamilycare.org aplicar en línea o llame al 1-800-701-0710 .
□ Sí Mi hijo tiene seguro de salud.
Doy el permiso para la foto de mi hijo y/o el nombre que se utiliza en los medios de comunicación : _____ No ____ Foto solo
____ Nombre / Foto
SERVICIOS DE SALUD DEL ESTUDIANTE
Yo, el abajo firmante, autorizo a los oficiales de Nueva Jersey de las Escuelas Públicas de contactar directamente con la persona ( s ) nombrada en esta tarjeta y
sí autorizo al médico indicado para prestar el tratamiento que se considere necesario en caso de emergencia, para la salud de dicho niño. En el caso de que los
médicos, otras personas nombradas en esta tarjeta, o los padres / tutores no pueden ser contactados, los oficiales de la escuela estarán autorizados a tomar las
medidas que consideren necesarias a su juicio, para la salud del niño antes mencionado. Yo no haré financieramente responsable al distrito escolar por la
atención de emergencia y / o transporte de dicho niño. Si, en circunstancias excepcionales, un niño debe tomar medicamentos durante el horario escolar y el
padre no puede estar en la escuela para administrar el medicamento, solamente la enfermera de la escuela administrará el medicamento de acuerdo con la
Política del Consejo 5330 ( Administración de Medicamentos ) .
Fecha: ______________ Padre (s ) tutor ( s ) Firma ___________________________________________
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❑Do NOT include my information in the directory.
MJS FAMILY DIRECTORY
Children’s Names
Last
First
Grade
Last
First
Grade
Last
First
Grade
Parent 1:
Name (First, Last)
Address
Phone
Cell Phone
Email
Parent 2:
Name (First, Last)
[if different than above]
Address
Phone
Cell Phone
Email
Every family receives ONE (1) directory.
You may purchase additional directories for $5 each.
I would like
ADDITIONAL directories. Please include payment with Dues Form.
4
Parents: To share exciting school activities and student accomplishments, we would like to post
recognition on the school website. Just as schools receive permission to publish names and
pictures in local newspapers, the state requires permission to post information on the website.
Please complete and return this state-required form to the school office. Thank you.
Parental/Guardian Consent Form
We are sending you this parental consent form to both inform you and to request permission for
your child.s photo/image and personally identifiable information to be published on the district
and/or school.s web site.
As you are aware, there are potential dangers associated with the posting of personally
identifiable information on a web site since global access to the Internet does not allow
us to control who may access such information. These dangers have always existed;
however, we as schools do want to celebrate your child and his/her work. The law
requires that we ask for your permission to use information about your child.
Pursuant to law, we will not release any personally identifiable information without prior written
consent from you as parent or guardian. Personally identifiable information includes student
names, photo or image, residential addresses, e-mail address, phone numbers and locations
and times of class trips.
If you, as the parent or guardian, wish to rescind this agreement, you may do so at any time in
writing by sending a letter to the principal of your child.s school and such rescission will take
effect upon receipt by the school.
Check one of the following choices:
I/We GRANT permission for a photo/image that includes this student without any other
personal identifiers to be published on the school and/or district.s public Internet site.
I/We GRANT permission for this student.s photo/image and name to be published on the
school and/or district.s public Internet site.
I/We GRANT permission for this student.s photo/image and all other personal identifiers
listed above to be published on the school and/or district.s public Internet site.
I/We DO NOT GRANT permission for photo/image that includes this student to be
published on the school and or district.s public Internet site.
Student.s Name: (please print) ________________________________Student’s Grade: _____
Print name of Parent/Guardian: (print)______________________________________________
Signature of Parent/Guardian: (sign) _______________________________________________
Relation to Student: ___________________________________________________________
Date: __________________
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Padres: Para compartir las actividades escolares y los logros de los estudiantes, nos gustaría
publicar reconocimiento por el sitio web de la escuela. Del mismo modo que las escuelas
reciben permiso para publicar los nombres y fotos en los periódicos locales, el estado requiere
permiso para publicar información en el sitio web. Favor de completar y devolver este formulario
requerido por el estado a la oficina de la escuela. Gracias.
Padres / Tutores Formulario de Consentimiento
Le estamos enviando este formulario de consentimiento de los padres para informarle y para
pedir permiso para la foto/imagen de su hijo/a y la información de identificación personal que se
publicará en el distrito y/o el sitio web de la escuela.
Como usted sabe, hay peligros posibles asociados con la publicación de la información de
identificación personal en un sitio web, ya que el acceso global a Internet no nos permite
controlar quien pueda acceder a dicha información. Estos peligros han existido siempre; sin
embargo, nosotros, las escuelas, sí queremos celebrar a su hijo y su trabajo. La ley requiere que
le pidamos su permiso para utilizar la información sobre su hijo.
De conformidad con la ley, nosotros no revelaremos ninguna información personal sin el
consentimiento previo por escrito de usted como padre o tutor. Información de identificación
personal incluye nombres de los estudiantes, la foto o la imagen, direcciones residenciales,
dirección de correo electrónico, números de teléfono y los lugares y horarios de los viajes de la
clase.
Si usted, como padre o tutor, desea rescindir este acuerdo, usted puede hacerlo en cualquier
momento por escrito mediante el envío de una carta al director de la escuela de su hijo y tal
rescisión tendrá efecto una vez recibida por la escuela.
Marque una de las siguientes opciones :
_____Damos permiso para una foto/imagen que incluye este estudiante sin otros
identificadores personales que se publicará en el sitio de la escuela y/o en el sitio de Internet del
distrito.
_____Damos permiso para la foto/imagen y el nombre de este estudiante que se publicarán
en el sito web de la escuela y/o en el sitio de Internet del distrito.
_____Damos permiso para la foto/imagen de este estudiante y todos los otros
identificadores personales mencionados anteriormente que se publicarán en el sitio web de la
escuela y/o en el sitio de Internet del distrito.
_____No damos permiso de foto/imagen que incluye este estudiante que se publicará en el
sitio web de la escuela ni en el sitio de Internet del distrito.
Nombre del Estudiante : ( en letra de imprenta ) ____________________________________
El nombre del padre / tutor :( letra de imprenta) ____________________________________
Firma del Padre / Guardián: __________________________________________________
Relación con el estudiante: ______________________________________________________
Fecha: ____________________________________________________________________
Maestro del Estudiante_______________________________________________________
5
MADISON PUBLIC SCHOOL DISTRICT
Guidelines for Computer and Internet Use
Dear Parents,
The Madison Public School District incorporates technology into the instructional program and provides students with
access to the Internet. We are very pleased to bring this access to District schools and believe the Internet offers vast,
diverse, and unique educationally relevant resources to both students and teachers. Our goal in providing this service to
teachers and students is to promote educational excellence in the schools by facilitating resource sharing, innovation,
and communication.
The Internet is an electronic highway connecting thousands of computers all over the world and millions of individual
subscribers. Students and teachers will have access to the World Wide Web, research institutions such as NASA,
University Library Catalogs, the Library of Congress; and many other collaborative projects for the educational
community.
As you probably are aware, the Internet has material available that is not educationally appropriate. We believe in
restricting access to controversial materials, and student access to the Internet will be controlled and monitored by their
teachers and by filtering software on all PCs. However, it may be impossible to control all materials that an industrious
user may discover. We firmly believe that the valuable information and interaction available on this worldwide network
far outweighs the possibility that users may find material that is not consistent with the educational goals of the District.
The use of the District’s computers provide a varied set of resources which also include computer programs and CDROMs. We expect this use to be consistent with our educational mission.
Enclosed you will find (2) contracts regarding use of the computers and the Internet. One is for the student user, and the
other for his/her parent/guardian. These documents have become standard in schools throughout the country. They
define acceptable use of these resources and the student’s agreement to abide by them. Please return them with the
requested signatures.
Following is Madison Public School District’s Computer/Internet Terms and Conditions of Use:
Acceptable Use - The purpose of the backbone networks making-up the Internet is to support research and education in
and among academic institutions by providing access to unique resources and the opportunity for collaborative work.
The use of the schools’ accounts must be in support of education and research and consistent with the educational
objectives of the Madison Public School District.
NO PERSON WILL DELIBERATELY OR WILLFULLY CAUSE DAMAGE TO COMPUTER EQUIPMENT OR
SOFTWARE OR ASSIST OTHERS IN DOING THE SAME; OR VIEW, ALTER OR DAMAGE THE FILES OF
OTHERS THAT ARE STORED ON THE COMPUTERS.
Privileges - The use of the computers and the Internet is a privilege, not a right, and inappropriate use will result in a
cancellation of those privileges. The school staff and network administrator will deem what is inappropriate use and
their decision is final.
Network Etiquette - Students are expected to abide by the generally accepted rules of network etiquette. These include,
but are not limited to, being polite in messages to others; using appropriate language; and not revealing personal
addresses or phone numbers.
Sincerely yours,
John LaPierre
Coordinator of Technology
Rev. 8/02/06
5
PARENT OR GUARDIAN CONTRACT REGARDING
THE USE OF COMPUTERS AND THE INTERNET
__ as the parent or guardian of
I,
________________________________________ who has signed a contract regarding the use of
computers and the Internet, have read the contract and the guidelines for use of computers and the
Internet. I understand that access to the Internet is designed for educational purposes. However, I
also recognize that it may be impossible for the Madison Public School District to restrict access to
all controversial materials, and I will not hold it responsible for any materials acquired on this
network. I also understand my child is expected to use computers in such a way as to cause no
damage to them or the files stored in them.
I release the Madison Public School District from any liability or damages that may result
from my son’s/daughter’s use of the Internet. The Madison Public School District denies any
responsibility for the accuracy or quality of information obtained through the Internet. In addition, I
will accept full responsibility and liability for the results of my son’s/daughter’s actions with regard
to the use of the Internet.
Further, I understand that the improper or inappropriate use of the Internet by my child shall
result in revocation of the privilege to access the network, school discipline, and possible criminal
and civil penalties.
Name of Parent or Guardian:
(Print Name)
(Signature)
Date:
* Return To Advisory Teacher
Rev. 8/02/06
(over)
5
STUDENT CONTRACT REGARDING THE
USE OF COMPUTERS AND THE INTERNET
I,
, accept and agree to abide by the following rules.
I have read and agree to abide by all rules which are listed in the Madison Public School District
Guidelines for Computer and Internet use.
I agree that I will neither deliberately nor willfully cause damage to computer equipment or software
or assist others in doing the same. I will not view, alter or damage the files of others that are stored on the
computers.
I realize that the primary purpose of the backbone networks making up the Internet is to support
research and education in and among academic institutions by providing access to unique resources and the
opportunity for collaborative work. The use of the schools’ accounts must be in support of education and
research consistent with the educational objectives of the Madison Public School District.
I realize that the use of Internet is a privilege not a right. I accept that any inappropriate behavior
may lead to penalties including cancellation of that privilege, disciplinary action and/or legal action. The
school staff shall deem what constitutes inappropriate use, and I will accept their decision as being final.
I agree that I will not willfully attempt to bypass or circumvent the districts Internet filtering system
or computer and network security settings.
I agree not to participate in the transfer of inappropriate or illegal materials through the Madison
Public School District Internet. I realize that the transfer of such material may result in legal action against
me.
I will abide by the generally accepted rules of network etiquette. These include, but are not limited
to, being polite in messages to others, using appropriate language and not revealing personal addresses or
phone numbers.
I release the Madison Public School District from any liability or damages that may result from my
use of the Internet connection. The Madison Public School District denies any responsibility for the accuracy
or quality of information obtained through the Internet. In addition, I will accept full responsibility and
liability for the results of my actions with regard to the use of Internet.
Name of User:
(Print Name)
(Student’s Signature)
Date:
Grade Level:
_______________
* Return To Advisory Teacher
Rev. 8/02/06
(over)
5
Directrices para la Computadora y el Uso de Internet
Estimados Padres,
El Distrito de Escuelas Públicas de Madison incorpora la tecnología en el programa de instrucción y proporciona a los
estudiantes el acceso a Internet. Estamos muy contentos de traer este acceso a las escuelas del Distrito y creemos que
Internet ofrece grandes y diversos recursos que son educativamente relevantes para los estudiantes y profesores.
Nuestro objetivo en la prestación de este servicio a los profesores y estudiantes es promover la excelencia educativa en
las escuelas, facilitando el intercambio de recursos, innovación y comunicación.
Internet es una autopista electrónica que conecta a miles de computadoras en todo el mundo y millones de suscriptores
individuales. Los estudiantes y los maestros tendrán acceso a la Web, las instituciones de investigación como la
NASA, los Catálogos de la Universidad Biblioteca, la Biblioteca del Congreso; y muchos otros proyectos de
colaboración para la comunidad educativa.
Como probablemente ya saben, Internet tiene material disponible, pero que no es siempre apropriado para los
estudiantes. Creemos en restringir el acceso a materiales controversiales, y acceso de los estudiantes a Internet será
controlado y monitoreado por sus profesores y por el filtro del software en todas las computadoras. Sin embargo,
puede que sea imposible controlar todos los materiales que un usuario industrioso puede descubrir. Creemos
firmemente que la información valiosa y la interacción disponible en esta red mundial vale más la posibilidad de que
los usuarios puedan encontrar material que no sea consistente con las metas educativas del Distrito.
El uso de las computadoras del Distrito proporciona varios recursos que también incluyen programas de computadora
y CD-ROM. Esperamos que este uso sea consistente con nuestra misión educativa.
Adjunto encontrará ( 2 ) contratos con respecto al uso de las computadoras e Internet. Uno es para el usuario
estudiante, y el otro para su padre/madre/tutor. Estos documentos se han convertido en norma en las escuelas de todo
el país . Ellos definen el uso aceptable de estos recursos y el acuerdo del estudiante para cumplir con las normas. Favor
de devolverlos con las firmas requeridas.
A continuación se presenta los Términos y Condiciones del Distrito de Escuelas Públicas de Madison para el uso de
Computadora e Internet:
Uso Aceptable - El propósito de las redes que forman Internet es apoyar la investigación y la educación entre
instituciones académicas mediante el acceso a recursos únicos y la oportunidad para el trabajo colaborativo. El uso de
las cuentas de las escuelas debe ser en apoyo de la educación y la investigación y consistente con los objetivos
educativos del Distrito de Escuelas Públicas de Madison.
NADIE DELIBERADAMENTE NI INTENCIONALMENTE CAUSARÁ DAÑOS AL EQUIPO DE
COMPUTADORA O SOFTWARE NI AYUDARÁ A OTROS A HACER LO MISMO; TAMPOCO LEERÁ,
ALTERARÁ NI DAÑARÁ LOS ARCHIVOS DE OTROS QUE SE ENCUENTREN EN LAS
COMPUTADORAS.
Privilegios - El uso de las computadoras e Internet es un privilegio, no un derecho, y el uso inapropiado resultará en la
cancelación de esos privilegios. El personal de la escuela y el administrador de la red decidirán cuál es el uso
inapropiado y su decisión es final.
Normas de Internet- Se espera que los estudiantes cumplan con las normas generalmente aceptadas de la red. Estas
normas incluyen, pero no se limitan a, ser educado y cortés en los mensajes a otros; usar un lenguaje apropiado; y no
revelar direcciones personales ni números de teléfono.
Atentamente,
John LaPierre
Coordinador de Tecnología
Rev. 02/08/06
5
CONTRATO PARA PADRE/MADRE O TUTOR
CON RESPECTO AL USO DE COMPUTADORAS E INTERNET
Yo,____________________ como padre, madre o tutor de________________________________
que ha firmado un contrato con respecto al uso de las computadoras y Internet, he leído el contrato
y las directrices para el uso de las computadoras y Internet. Yo entiendo que el acceso a Internet
está diseñado para propósitos educativos. Sin embargo, también reconozco que puede ser
imposible para el Distrito de Escuelas Públicas de Madison para restringir el acceso a todos los
materiales controversiales, y no voy a hacerle responsable de todos los materiales adquiridos en
esta red. También entiendo que se espera que mi hijo use las computadoras de una manera tal que
no cause ningún daño a ellas ni los archivos guardados en ellas.
Yo libero el Distrito de Escuelas Públicas de Madison de cualquier responsabilidad o daños que
puedan resultar del uso de mi hijo/a de Internet. El Distrito de Escuelas Públicas de Madison niega
cualquier responsabilidad por la exactitud o calidad de información obtenida a través de Internet.
Además, voy a aceptar la plena responsabilidad por los resultados de las acciones de mi hijo/a con
respecto a la utilización de Internet.
Además, entiendo que el uso inapropiado de Internet por parte de mi hijo/a resultará en la
revocación del privilegio de tener acceso a la red, la disciplina de la escuela, y las posibles
sanciones penales y civiles.
Nombre del Padre/Madre o Tutor : ____________________________
(Nombre/ Apellido )
____________________________
(Firma )
Fecha:
___________________________
Maestro:
__________________________
5
CONTRATO PARA EL ESTUDIANTE
CON RESPECTO AL USO DE COMPUTADORAS E INTERNET
Yo,_______________________, acepto y prometo a cumplir con las siguientes reglas.
He leído y estoy de acuerdo con todas las reglas que están escritas en Las Directrices para la Computadora y
el Uso de Internet del Distrito de Escuelas Públicas de Madison.
Estoy de acuerdo que no causaré daño ni deliberadamente ni intencionalmente al equipo de computadora o
software ni ayudaré a otros a hacer lo mismo. No voy a leer, alterar ni dañar los archivos de otras personas
que están en las computadoras.
Entiendo que el propósito principal de las redes que forman Internet es apoyar la investigación y la
educación entre instituciones académicas mediante el acceso a recursos únicos y la oportunidad para el
trabajo colaborativo. El uso de cuentas de las escuelas debe ser en apoyo de la educación y la investigación
y consistente con los objetivos educativos del Distrito de Escuelas Públicas de Madison.
Entiendo que el uso de Internet es un privilegio no un derecho. Acepto que cualquier comportamiento
inapropiado pueda resultar en sanciones que incluyan la cancelación de ese privilegio, una acción
disciplinaria y/o acción legal. El personal escolar decidirá lo que constituye un uso inapropiado, y voy a
aceptar su decisión como final.
Estoy de acuerdo en que no voy voluntariamente intentar anular o eludir ni el sistema de filtros ni la
configuración de seguridad de red.
Estoy de acuerdo en no participar en la transferencia de materiales inapropiados o ilegales a través de
Internet del Distrito de Escuelas Públicas de Madison. Entiendo que la transferencia de este tipo de
material pueda resultar en acciones legales contra mí.
Me atendré a las normas generalmente aceptadas de la red. Estas normas incluyen, pero no están limitadas
a, ser educado y cortés en los mensajes a otros, utilizar un lenguaje apropiado, y no revelar direcciones
personales ni números de teléfono.
Yo libero el Distrito de Escuelas Públicas de Madison de cualquier responsabilidad o daños que puedan
resultar de mi uso de la conexión a Internet. El Distrito de Escuelas Públicas de Madison niega cualquier
responsabilidad por la exactitud o calidad de información obtenida a través de Internet. Además , voy a
aceptar la plena responsabilidad por los resultados de mis acciones en relación con el uso de Internet.
Nombre de Usuario:____________________________
(Nombre )
____________________________
( Firma del estudiante )
Fecha :
___________________________
Maestro:
Rev. 02/08/06
____________________________
5
6
BOARD OF EDUCATION OF THE BOROUGH OF MADISON
359 Woodland Road • Madison, NJ 07940 • (973) 593-3101 • Fax (973) 593-3161
Dr. Michael A. Rossi, Jr.
Superintendent
Gary S. Lane
Business Administrator/
Board Secretary
Dear Parents,
The Madison Public School District is about to embark on a pilot program to evaluate the use
of Google Chromebook tablets. In order to run the pilot, the District will need to provide your
child with a Google account. This will provide your child with a password protected cloud
based storage account that is accessible from any internet capable device.
The District feels that this experience has the potential to greatly enhance the learning
environment. In order to assure that all parents of students participating in this program are
fully informed, we ask that you please sign this letter and send it back to school with your
child. All letters will be collected in class and submitted to the main office.
If you have any questions or concerns please feel free to contact me at
[email protected] or by phone at 973-593-3101 ext.8957.
Thank you.
John LaPierre
Coordinator of Technology
Madison Public Schools
___________________________________________________________________________
I give permission for the Madison Public School s to set up a Google account for my child.
_________________________________
Student Name (Please Print)
_________________________________
Parent Signature
____________________________
Date
7
160 Main Street
Phone: 973-593-3149
Fax: 973-966-1908
SCHOOL YEAR 2014 - 2015
_________________________________
STUDENT'S NAME
_________
GRADE
I understand that during the course of the school year, trips to the fire house, post office,
bank, YMCA, library, parks, local businesses, and to other schools for athletic events,
programs, class picnics, etc., are sometimes made.
If these trips are within reasonable walking distance for the children, and are carefully
planned and supervised by the teacher, I hereby give my consent for my child to make
such trips.
I am aware that even when every precaution is taken, unavoidable accidents may
happen. I will not hold the teacher or the school responsible should such an accident
occur.
____________________________
Signature of Parent
7
160 Main Street
Phone: 973-593-3149
Fax: 973-966-1908
Field Trip Guidelines




Dress Code Applies
The MJS Code of Conduct Applies
If the teacher allows electronic devices, the school is not responsible for lost or stolen electronic devices.
Any behavior or possibility of behavior that will result in physical, psychological, social or emotional harm to
another is unacceptable. Below are some specific examples of behaviors that should be avoided:
o Hitting, pushing, kicking, tripping, spitting
o Initiating or spreading rumors/gossiping/sharing unnecessary information about others
o Bullying
o Instigating a fight
o Unacceptable bus behavior
o Stealing or blackmail
o Use of a weapon
o Use verbally or written words like: kill, shoot, pop, sniper, or anything that resembles these words
Students should:
 Follow directions of any staff member the first time they are given.
 Keep hands, feet, and objects to yourself, even when playing around. No roughhousing.
 Do not chew gum at any time unless authorized.
 Report at times given and follow field trip procedures set out by the person in charge.
 Not bring any objects to school which could potentially be used as weapons or which resemble weapons.
Note: This list is not all inclusive; it is merely a sampling of some examples of inappropriate behavior.
Consequences:
o Student could lose the privilege of future field trips of they do not obey the code of conduct/dress code.
o Students could potentially lose other privileges or receive other consequences depending on behavior.
o Administration reserves the right to administer ranging consequences based on various behaviors.
Students that acquire 12 or more points or are currently failing a class will not be permitted to attend a field trip unless the
field trip is deemed mandatory by the classroom teacher.
TOR/Lunch Detention/Wednesday Detention=1 Point
Friday Detention=3 Points
Saturday Detention=4 Points
Suspension=5 Points for each day suspended
If a student does acquire 12 points they may earn back one point for each week the student goes without any of the
aforementioned infractions.
160 Main Street
Mary Jane Skordinsky, RN, CSN
973 -593-3149
X 3196
Fax: 973-966-1908
Medications at school
If the medication must be given during school hours, the school nurse can administer it provided that
certain regulations are followed:
•
Over the counter and prescription medications: You and your doctor will need to complete
the form “Permission for Medication.” All medication must be sealed and unopened with the
child’s name clearly marked on the bottle. All prescription medication must be properly labeled
with the child’s name, name of medication, administration instructions, doctor’s name and date.
•
Asthmatic inhalers: Complete the Asthma Treatment Plan with your physician and have your
child carry or keep an inhaler in the school nurse’s office.
•
Anaphylactic allergies: Complete the Allergy Action Plan with your physician and have your
child carry or keep an epipen in the nurse’s office.
Scoliosis Screenings:
The New Jersey Department of Education requires that all public school pupils between the ages of ten
through eighteen be screened for scoliosis every two years. Scoliosis is defined as a condition of the
spine in which the spine may curve to the left or the right. It is most commonly found during time of
rapid growth and may progress if not treated. The procedure for screening is a simple one, but will
require the removal of the student’s shirt to expose the spine and shoulders. If your child is currently
under treatment for a spinal problem and you wish he/she to be exempt, you may do so in writing.
Thank you for your cooperation.
9
Madison Public Schools
School Health Services – Health Evaluation
NAME_______________________________________________________DATE ___________________________GRADE ________
PHYSICIAN__________________________________________________ TELEPHONE____________________________________
The responsibility of the school in emergency situations is to give immediate care, notify parents, and see that the child is placed under
responsible care of an adult which is authorized by the parent. Please complete the following form and to the school nurse NO LATER
THAN FRIDAY, Septermber 5, 2014.
Please indicate if your child has any of the following medical conditions by placing an “X” in the blank before each condition
then complete the section to the right of the medical condition.
_______ 1. ALLERGIES
List_________________________________________________________________
Does your child require medication at school for an anaphylaxis or severe reaction?
Yes _______ No ______ Medication: _____________________________________
** Submit physician orders for all medication taken at school
_______ 2. ASTHMA
Does your child require an inhaler** at school? Yes_______ No __________
** Submit physician orders for all medication taken at school
_______ 3. BRONCHIAL CONDITION
Specify ___________________________________________________________
_______ 4. CONVULSIONS/SEIZURES
Cause
_______ 5. DIABETIES
Please submit physician orders for diabetic care. ___________________________
_______ 6. FREQUENT HEADACHES
Cause, if known _____________________________________________________
_______ 7. FREQUENT USE OF BATHROOM
Cause, if known _____________________________________________________
_______ 8. FREQUENT NOSEBLEEDS
Cause, if known _____________________________________________________
_______ 9. HEART CONDITION*
Cause, if known _____________________________________________________
(*excluded from physical education only with written approval of physician)
_______10. PHYSICAL CONDITIONS*
____________________________________________________________________
(*excluded from physical education only with written approval of physician)
_______11. HEARING PROBLEMS
Specify_______________________________________________________________
_______12.VISION PROBLEMS
Specify_______________________________________________________________
_________________________________ Medication _________________
Eyeglasses worn during physical education? _________________________________
_______13.SKIN PROBLEMS
Specify_______________________________________________________________
If there are other health problems that we should be aware of, please explain on the back of this form.
Is your child on any medication? If so, please indicate: ___________________________________________________________
Any recent serious injury or procedures: ________________________________________________________________________
Permission is granted to share the above medical information with appropriate school personnel.
_______
Date
_________________________________________ __________
Print Guardian’s Name
__________________________________________
Signature
hlthhis.doc 6/14 revised
10
160 Main Street
Mary Jane Skordinsky, RN, CSN
973 -593-3149 Ext. 3
Fax: 973-966-1908
Sixth Grade Immunization and Physical
Examination Requirements
1.
The New Jersey State Department of Health & Senior Services immunization regulations
(N.J.A.C. 8:57-4) require your child be vaccinated prior to entering grade 6 in September 2014.
Any student not in compliance may be excluded from attending school by the Board of Health
until their immunizations are up to date. Proof of immunization is required before September
4, 2014 for the following:
Tdap (Tetanus, diphtheria and accellar pertussis)
Meningitis Vaccine
2. The NJDHSS recognizes the importance of obtaining medical examinations of students at least
once during the developmental stages of grade four through six. Please provide documentation
of a 6th grade physical examination to the school nurse.
For those students whose birthday falls after the start of school in September 2014; the student will
be required to receive the vaccines as soon as they turn 11 years of age. Proof of a physician’s
appointment should be sent to the school nurse. If you are uninsured, contact the Madison Health
Department at 973-593-3079.
************************************************************************************
Print Student Name:
__________________________________________________________________________________
Tdap received on: _________________
Meningitis Vaccine received on: __________________
Print Physician’s Name: ______________________________________________________________
Physician signature: _____________________________________________ Date: _______________
Telephone: _____________________
Physician Stamp:
11
160 Main Street
Phone: 973-593-3149
Fax: 973-966-1908
August 2014
Dear 8th Grade Parent/Guardian:
Please print the name of your child on the lines below that would appear and be used on
diplomas, honor roll certificates, graduation program, etc. It is very important that the
information be correct for all documents. If this information is not returned, your child’s
name will remain as it appears on the emergency card.
Thank you,
MJS Office
Last Name:
_
First Name:
_
Middle Name or Initial:
_
Parent Signature verifying that the information above is correct
12
PLACE
PICTURE
HERE
Name: _________________________________________________________________________ D.O.B.: ____________________
Allergy to: __________________________________________________________________________________________________
Weight: ________________ lbs. Asthma:
[ ] Yes (higher risk for a severe reaction) [ ] No
NOTE: Do not depend on antihistamines or inhalers (bronchodilators) to treat a severe reaction. USE EPINEPHRINE.
Extremely reactive to the following foods: ____________________________________________________________
THEREFORE:
[ ] If checked, give epinephrine immediately for ANY symptoms if the allergen was likely eaten.
[ ] If checked, give epinephrine immediately if the allergen was definitely eaten, even if no symptoms are noted.
MILD SYMPTOMS
FOR ANY OF THE FOLLOWING:
SEVERE SYMPTOMS
LUNG
Short of breath,
wheezing,
repetitive cough
SKIN
Many hives over
body, widespread
redness
1.
HEART
Pale, blue,
faint, weak
pulse, dizzy
GUT
Repetitive
vomiting, severe
diarrhea
THROAT
Tight, hoarse,
trouble
breathing/
swallowing
OTHER
Feeling
something bad is
about to happen,
anxiety, confusion
MOUTH
Significant
swelling of the
tongue and/or lips
OR A
COMBINATION
of symptoms
from different
body areas.
NOSE
Itchy/runny
nose,
sneezing
MOUTH
Itchy mouth
SKIN
A few hives,
mild itch
GUT
Mild nausea/
discomfort
FOR MILD SYMPTOMS FROM MORE THAN ONE
SYSTEM AREA, GIVE EPINEPHRINE.
FOR MILD SYMPTOMS FROM A SINGLE SYSTEM
AREA, FOLLOW THE DIRECTIONS BELOW:
1. Antihistamines may be given, if ordered by a
healthcare provider.
2. Stay with the person; alert emergency contacts.
3. Watch closely for changes. If symptoms worsen,
give epinephrine.
INJECT EPINEPHRINE IMMEDIATELY.
2.
Call 911. Tell them the child is having anaphylaxis and may
need epinephrine when they arrive.
MEDICATIONS/DOSES
•
Consider giving additional medications following epinephrine:
Epinephrine Brand: __________________________________________
»
»
•
Antihistamine
Inhaler (bronchodilator) if wheezing
Epinephrine Dose:
Lay the person flat, raise legs and keep warm. If breathing is
difficult or they are vomiting, let them sit up or lie on their side.
[ ] 0.15 mg IM
[ ] 0.3 mg IM
Antihistamine Brand or Generic: _______________________________
•
If symptoms do not improve, or symptoms return, more doses of
epinephrine can be given about 5 minutes or more after the last dose.
Antihistamine Dose: __________________________________________
•
Alert emergency contacts.
Other (e.g., inhaler-bronchodilator if wheezing): __________________
•
Transport them to ER even if symptoms resolve. Person should
remain in ER for at least 4 hours because symptoms may return.
____________________________________________________________
PARENT/GUARDIAN AUTHORIZATION SIGNATURE
DATE
PHYSICIAN/HCP AUTHORIZATION SIGNATURE
FORM PROVIDED COURTESY OF FOOD ALLERGY RESEARCH & EDUCATION (FARE) (WWW.FOODALLERGY.ORG) 5/2014
DATE
12
EPIPEN® (EPINEPHRINE) AUTO-INJECTOR DIRECTIONS
2
1. Remove the EpiPen Auto-Injector from the plastic carrying case.
2. Pull off the blue safety release cap.
3. Swing and firmly push orange tip against mid-outer thigh.
4. Hold for approximately 10 seconds.
4
5. Remove and massage the area for 10 seconds.
AUVI-QTM (EPINEPHRINE INJECTION, USP) DIRECTIONS
2
1. Remove the outer case of Auvi-Q. This will automatically activate the voice
instructions.
3
2. Pull off red safety guard.
3. Place black end against mid-outer thigh.
4. Press firmly and hold for 5 seconds.
5. Remove from thigh.
ADRENACLICK®/ADRENACLICK® GENERIC DIRECTIONS
1. Remove the outer case.
2
3
2
2. Remove grey caps labeled “1” and “2”.
3. Place red rounded tip against mid-outer thigh.
1
4. Press down hard until needle penetrates.
5. Hold for 10 seconds. Remove from thigh.
OTHER DIRECTIONS/INFORMATION (may self-carry epinephrine, may self-administer epinephrine, etc.):
Treat the person before calling emergency contacts. The first signs of a reaction can be mild, but symptoms can get worse quickly.
EMERGENCY CONTACTS — CALL 911
OTHER EMERGENCY CONTACTS
NAME/RELATIONSHIP: __________________________________________________________________
RESCUE SQUAD: ______________________________________________________________________
PHONE: ______________________________________________________________________________
DOCTOR: _________________________________________________ PHONE: ____________________
NAME/RELATIONSHIP: __________________________________________________________________
PARENT/GUARDIAN: ______________________________________ PHONE: ____________________
PHONE: _______________________________________________________________________________
PARENT/GUARDIAN AUTHORIZATION SIGNATURE
DATE
FORM PROVIDED COURTESY OF FOOD ALLERGY RESEARCH & EDUCATION (FARE) (WWW.FOODALLERGY.ORG) 5/2014
Asthma Treatment Plan – Student
13
Sponsored by
(This asthma action plan meets NJ Law N.J.S.A. 18A:40-12.8) (Physician’s Orders)
(Please Print)
Name
Date of Birth
Doctor
Phone
HEALTHY (Green Zone)
You have all of these:
• Breathing is good
• No cough or wheeze
• Sleep through
the night
• Can work, exercise,
and play
Effective Date
Parent/Guardian (if applicable)
Emergency Contact
Phone
Phone
Take daily control medicine(s). Some inhalers may be
more effective with a “spacer” – use if directed.
MEDICINE
HOW MUCH to take and HOW OFTEN to take it
Advair ® HFA 45, 115, 230 ____________2 puffs twice a day
Alvesco® 80, 160 ______________________ 1, 2 puffs twice a day
Dulera® 100, 200 _____________________2 puffs twice a day
Flovent ® 44, 110, 220 _______________2 puffs twice a day
Qvar ® 40, 80 ________________________ 1, 2 puffs twice a day
Symbicort ® 80, 160 ___________________ 1, 2 puffs twice a day
Advair Diskus® 100, 250, 500 _________1 inhalation twice a day
Asmanex® Twisthaler ® 110, 220___________ 1, 2 inhalations once or twice a day
Flovent ® Diskus® 50 100 250 _________1 inhalation twice a day
Pulmicort Flexhaler ® 90, 180 ____________ 1, 2 inhalations once or twice a day
Pulmicort Respules® (Budesonide) 0.25, 0.5, 1.0__1 unit nebulized once or twice a day
Singulair® (Montelukast) 4, 5, 10 mg _____1 tablet daily
Other
None
Triggers
Check all items
that trigger
patient’s asthma:
Colds/flu
Exercise
Allergens
Dust Mites,
dust, stuffed
animals, carpet
Pollen - trees,
grass, weeds
Mold
Pets - animal
dander
Pests - rodents,
cockroaches
Odors (Irritants)
And/or Peak flow above _______
Cigarette smoke
& second hand
Remember to rinse your mouth after taking inhaled medicine.
smoke
If exercise triggers your asthma, take this medicine_____________________ ____minutes before exercise. Perfumes,
cleaning
products,
Continue daily control medicine(s) and ADD quick-relief medicine(s).
scented
products
You have any of these:
MEDICINE
Smoke from
• Cough
burning wood,
Combivent® Maxair® Xopenex ®_____________2 puffs every 4 hours as needed
• Mild wheeze
inside or outside
®
®
® ______________2 puffs every 4 hours as needed
Pro-Air
Proventil
Ventolin
• Tight chest
Weather
Albuterol 1.25, 2.5 mg ___________________1 unit nebulized every 4 hours as needed
Sudden
• Coughing at night
temperature
Duoneb® __________________________________1 unit nebulized every 4 hours as needed
• Other:___________
change
® (Levalbuterol)
0.31, 0.63, 1.25 mg _1 unit nebulized every 4 hours as needed
Xopenex
Extreme weather
Increase the dose of, or add:
- hot and cold
If quick-relief medicine does not help within
Ozone alert days
Other
15-20 minutes or has been used more than
Foods:
2 times and symptoms persist, call your
doctor or go to the emergency room.
And/or Peak flow from______ to_____
EMERGENCY (Red Zone)
• If quick-relief medicine is needed more than 2 times a
week, except before exercise, then call your doctor.
Your asthma is
getting worse fast:
• Quick-relief medicine did
not help within 15-20 minutes
• Breathing is hard or fast
• Nose opens wide • Ribs show
• Trouble walking and talking
• Lips blue • Fingernails blue
• Other:________________
And/or
Peak flow
below ______
Disclaimers: The use of this Website/PACNJ Asthma Treatment Plan and its content is at your own risk. The content is
provided on an “as is” basis. The American Lung Association of the Mid-Atlantic (ALAM-A), the Pediatric/Adult Asthma
Coalition of New Jersey and all affiliates disclaim all warranties, express or implied, statutory or otherwise, including but not
limited to the implied warranties or merchantability, non-infringement of third parties’ rights, and fitness for a particular purpose.
ALAM-A makes no representations or warranties about the accuracy, reliability, completeness, currency, or timeliness of the
content. ALAM-A makes no warranty, representation or guaranty that the information will be uninterrupted or error free or that any
defects can be corrected. In no event shall ALAM-A be liable for any damages (including, without limitation, incidental and
consequential damages, personal injury/wrongful death, lost profits, or damages resulting from data or business interruption)
resulting from the use or inability to use the content of this Asthma Treatment Plan whether based on warranty, contract, tort or
any other legal theory, and whether or not ALAM-A is advised of the possibility of such damages. ALAM-A and its affiliates are
not liable for any claim, whatsoever, caused by your use or misuse of the Asthma Treatment Plan, nor of this website.
The Pediatric/Adult Asthma Coalition of New Jersey is sponsored by the American Lung Association in New Jersey. This publication was supported by a grant from the New Jersey Department of Health and Senior Services, with funds provided by the U.S. Centers for Disease Control and Prevention under Cooperative Agreement 5U59EH000491-03. Its content are solely the responsibility
of the authors and do not necessarily represent the official views of the New Jersey Department of Health and Senior Services or the
U.S. Centers for Disease Control and Prevention.Although this document has been funded wholly or in part by the United States
Environmental Protection Agency under Agreement XA97250908-4 to the American Lung Association in New Jersey, it has not gone
through the Agency’s publications review process and therefore, may not necessarily reflect the views of the Agency and no official
endorsement should be inferred. Information in this publication is not intended to diagnose health problems or take the place of
medical advice. For asthma or any medical condition, seek medical advice from your child’s or your health care professional.
REVISED JULY 2012
Permission to reproduce blank form • www.pacnj.org
Take these medicines NOW and CALL 911.
Asthma can be a life-threatening illness. Do not wait!
MEDICINE
Combivent® Maxair® Xopenex ® ______________2 puffs every 20 minutes
Ventolin ® Pro-Air® Proventil ® ________________2 puffs every 20 minutes
Albuterol 1.25, 2.5 mg _____________________1 unit nebulized every 20 minutes
Duoneb® ____________________________________1 unit nebulized every 20 minutes
Xopenex ® (Levalbuterol) 0.31, 0.63, 1.25 mg ___1 unit nebulized every 20 minutes
Other
Permission to Self-administer Medication:
This student is capable and has been instructed
in the proper method of self-administering of the
non-nebulized inhaled medications named above
in accordance with NJ Law.
This student is not approved to self-medicate.
Other:
This asthma treatment
plan is meant to assist,
not replace, the clinical
decision-making
required to meet
individual patient needs.
PHYSICIAN/APN/PA SIGNATURE______________________________ DATE__________
PARENT/GUARDIAN SIGNATURE______________________________
PHYSICIAN STAMP
Make a copy for parent and for physician file, send original to school nurse or child care provider.
13
Asthma Treatment Plan – Student
Parent Instructions
The PACNJ Asthma Treatment Plan is designed to help everyone understand the steps necessary for the
individual student to achieve the goal of controlled asthma.
1. Parents/Guardians: Before taking this form to your Health Care Provider, complete the top left section with:
• Child’s name
• Child’s doctor’s name & phone number
• Parent/Guardian’s name
• Child’s date of birth
• An Emergency Contact person’s name & phone number
& phone number
2. Your Health Care Provider will complete the following areas:
• The effective date of this plan
• The medicine information for the Healthy, Caution and Emergency sections
• Your Health Care Provider will check the box next to the medication and check how much and how often to take it
• Your Health Care Provider may check “OTHER” and:
Write in asthma medications not listed on the form
Write in additional medications that will control your asthma
Write in generic medications in place of the name brand on the form
• Together you and your Health Care Provider will decide what asthma treatment is best for your child to follow
3. Parents/Guardians & Health Care Providers together will discuss and then complete the following areas:
• Child’s peak flow range in the Healthy, Caution and Emergency sections on the left side of the form
• Child’s asthma triggers on the right side of the form
• Permission to Self-administer Medication section at the bottom of the form: Discuss your child’s ability to self-administer the
inhaled medications, check the appropriate box, and then both you and your Health Care Provider must sign and date the form
4. Parents/Guardians: After completing the form with your Health Care Provider:
• Make copies of the Asthma Treatment Plan and give the signed original to your child’s school nurse or child care provider
• Keep a copy easily available at home to help manage your child’s asthma
• Give copies of the Asthma Treatment Plan to everyone who provides care for your child, for example: babysitters,
before/after school program staff, coaches, scout leaders
PARENT AUTHORIZATION
I hereby give permission for my child to receive medication at school as prescribed in the Asthma Treatment Plan. Medication must be provided
in its original prescription container properly labeled by a pharmacist or physician. I also give permission for the release and exchange of
information between the school nurse and my child’s health care provider concerning my child’s health and medications. In addition, I
understand that this information will be shared with school staff on a need to know basis.
Parent/Guardian Signature
Phone
Date
STUDENT AUTHORIZATION FOR SELF ADMINISTRATION OF ASTHMA MEDICATION
RECOMMENDATIONS ARE EFFECTIVE FOR ONE (1) SCHOOL YEAR ONLY AND MUST BE RENEWED ANNUALLY
I do request that my child be ALLOWED to carry the following medication ________________________________ for self-administration
in school pursuant to N.J.A.C:.6A:16-2.3. I give permission for my child to self-administer medication, as prescribed in this Asthma Treatment
Plan for the current school year as I consider him/her to be responsible and capable of transporting, storing and self-administration of the
medication. Medication must be kept in its original prescription container. I understand that the school district, agents and its employees
shall incur no liability as a result of any condition or injury arising from the self-administration by the student of the medication prescribed
on this form. I indemnify and hold harmless the School District, its agents and employees against any claims arising out of self-administration
or lack of administration of this medication by the student.
I DO NOT request that my child self-administer his/her asthma medication.
Phone
Date
Disclaimers: The use of this Website/PACNJ Asthma Treatment Plan and its content is at your own risk. The content is provided on an “as is” basis. The American Lung Association of the Mid-Atlantic (ALAM-A), the Pediatric/Adult Asthma Coalition of
New Jersey and all affiliates disclaim all warranties, express or implied, statutory or otherwise, including but not limited to the implied warranties or merchantability, non-infringement of third parties’ rights, and fitness for a particular purpose. ALAM-A makes
no representations or warranties about the accuracy, reliability, completeness, currency, or timeliness of the content. ALAM-A makes no warranty, representation or guaranty that the information will be uninterrupted or error free or that any defects can be
corrected. In no event shall ALAM-A be liable for any damages (including, without limitation, incidental and consequential damages, personal injury/wrongful death, lost profits, or damages resulting from data or business interruption) resulting from the use
or inability to use the content of this Asthma Treatment Plan whether based on warranty, contract, tort or any other legal theory, and whether or not ALAM-A is advised of the possibility of such damages. ALAM-A and its affiliates are not liable for any claim,
whatsoever, caused by your use or misuse of the Asthma Treatment Plan, nor of this website.
The Pediatric/Adult Asthma Coalition of New Jersey is sponsored by the American Lung Association in New Jersey. This publication was supported by a grant from the New Jersey Department of Health and Senior Services, with funds provided by the U.S.
Centers for Disease Control and Prevention under Cooperative Agreement 5U59EH000491-03. Its content are solely the responsibility of the authors and do not necessarily represent the official views of the New Jersey Department of Health and Senior Services
or the U.S. Centers for Disease Control and Prevention.Although this document has been funded wholly or in part by the United States Environmental Protection Agency under Agreement XA97250908-4 to the American Lung Association in New Jersey, it has
not gone through the Agency’s publications review process and therefore, may not necessarily reflect the views of the Agency and no official endorsement should be inferred. Information in this publication is not intended to diagnose health problems or take
the place of medical advice. For asthma or any medical condition, seek medical advice from your child’s or your health care professional.
Sponsored by
14
Permission for Medication Administration by the School Nurse
MJS School Year: 2014-2015
Student: _______________________________________ Birthdate: ________ Grade: _______
Diagnosis/Purpose of medication: ___________________________________________________
Name of medication: _____________________________________________________________
Dosage: _______________________________________________________________________
Frequency/Time given at school: ____________________________________________________
Possible side effects: _____________________________________________________________
Date medication will be discontinued: ________________________________________________
The above named student is physically fit to attend school and is free of contagious disease.
He/She would not be able to attend school if medication is not administered during school hours.
Physician Signature: _____________________________________________ Date: __________
Physician’s Stamp:
Phone: ___________________
==========================================================================
Parent Acknowledgement and Authorization
The parents/guardians hereby authorize the school nurse to administer the above medication as
evidenced by our submission of the above Physician Certification. By signing this acknowledgement,
we understand that the Board, its employees, or agents shall incur no liability as a result of any injury
arising from the administration of any medication to the pupil, and that we hereby indemnify and hold
harmless the Board, its employees, or agents against any claims arising out of the administration of
the medication by the staff.
Parent signature: _________________________________________ Date: ________________
Parent (print): _________________________________________________________________
Phone: _______________________________________________________________________
BOARD OF EDUCATION OF THE BOROUGH OF MADISON
359 Woodland Road • Madison, NJ 07940 • (973) 593-3100 • Fax (973) 593-3161
Dr. Michael A. Rossi, Jr.
Superintendent
Gary S. Lane
Business Administrator/
Board Secretary
TO:
FROM:
RE:
Parents/Guardians
Gary Lane
Student Accident Insurance
Voluntary Insurance Enrollment
Claims Filing Instructions
DATE:
August 2014
_____________________________________________________________________
_
Voluntary Enrollment in Student Accident Insurance Program:
The Board of Education has arranged to make available for your purchase a low cost student accident
insurance plan for the 2014-15 school year. The district is transitioning from our prior carrier (Bollinger) to
Monarch Management Corporation. The purchase of this insurance coverage is directly between the family
and the insurance company. Although this plan is a comprehensive one, it does not necessarily provide
payment
for
all
expenses
incurred
in
an
accident.
Please
visit
http://www.policyxl.com/monarch/sa_enrollment.html and review all the information to fully understand the
product Monarch is offering. This information can also be found by visiting our website at
www.madisonpublicschools.org, click the “Health Services Tab” at the top, click the links on the left side of
the page.
Voluntary enrollment information is available electronically on their website. For those wishing to enroll, the
sign up is completed online at the following link - http://www.policyxl.com/monarch/sa_enrollment.html. The
parent/guardian simply begins by selecting the home district—Madison—from the drop down menu and
follow the instructions to completion.
Claims Filing Instructions:
In the event you need to file a claim, all claims will shift primarily to online reporting. The link to the online
portal for claims reporting is found on the Monarch Management page – www.mmc-ins.com/admin/formtester.html. The Madison School District is already setup with a single username and password that can be
used to initiate student accident claims through the online portal. These credentials are below. Please use the
online system as the primary method of inputting claims. In the event that online access is not available or
feasible, the attached paper claim form can be used. This form can also be found on our website under the
Health Services Tab. Please note that a claim should still be input online following faxed/mailed submission
of the paper claim form. This will not result in duplicate claims files being opened. Once claims are
submitted, Preferred Care Inc. (the program’s claims processor) will contact parents directly for any
supplemental information or paperwork. Please be as thorough as possible in completing any claims
submission. Parents can access an online video that walks first-time users through the claims submission
process. That video can be accessed at:
http://www.mmc-ins.com/admin/training/training.htm .
Please note that the links to the Monarch main page, claims submission, and voluntary plan enrollment pages
are also available on our insurance agent’s website, Brown & Brown Public Risk Advisors– www.bbpra.com.
Username: MADISON
Password: 666142
Questions should be made directly to Monarch at 800-662-2778.
Cc:
Principals
Student Ins. Memo Summer E-Mail.doc./Forms Memos Letters Etc./Prin/Adm Memos/MYDocuments
Website Resources
●
Sudden Death in Athletes
http://tinyurl.com/m2gjmvq
●
Hypertrophic Cardiomyopathy Association
www.4hcm.org
●
American Heart Association www.heart.org
Collaborating Agencies:
American Academy of Pediatrics
New Jersey Chapter
3836 Quakerbridge Road, Suite 108
Hamilton, NJ 08619
(p) 609-842-0014
(f ) 609-842-0015
www.aapnj.org
American Heart Association
1 Union Street, Suite 301
Robbinsville, NJ, 08691
(p) 609-208-0020
www.heart.org
New Jersey Department of Education
PO Box 500
Trenton, NJ 08625-0500
(p) 609-292-5935
www.state.nj.us/education/
SUDDEN
CARDIAC
DEATH
IN
YOUNG
ATHLETES
The Basic Facts on
Sudden Cardiac Death
in Young Athletes
New Jersey Department of Health
P. O. Box 360
Trenton, NJ 08625-0360
(p) 609-292-7837
www.state.nj.us/health
Lead Author: American Academy of Pediatrics,
New Jersey Chapter
Written by: Initial draft by Sushma Raman Hebbar,
MD & Stephen G. Rice, MD PhD
Additional Reviewers: NJ Department of Education,
NJ Department of Health and Senior Services,
American Heart Association/New Jersey Chapter,
NJ Academy of Family Practice, Pediatric Cardiologists,
New Jersey State School Nurses
Revised 2014: Nancy Curry, EdM;
Christene DeWitt-Parker, MSN, CSN, RN;
Lakota Kruse, MD, MPH; Susan Martz, EdM;
Stephen G. Rice, MD; Jeffrey Rosenberg, MD,
Louis Teichholz, MD; Perry Weinstock, MD
S
SU DD EN C A RD IA C DE ATH I N YOU NG ATH L ET ES
udden death in young athletes
between the ages of 10
and 19 is very rare.
What, if anything, can be
done to prevent this kind of
tragedy?
What is sudden cardiac death
in the young athlete?
Sudden cardiac death is the
result of an unexpected failure of proper
heart function, usually (about 60% of the
time) during or immediately after exercise
without trauma. Since the heart stops
pumping adequately, the athlete quickly
collapses, loses consciousness, and
ultimately dies unless normal heart rhythm
is restored using an automated external
defibrillator (AED).
How common is sudden death in young
athletes?
STATE OF NEW JERSEY
DEPARTMENT OF EDUCATION
Sudden cardiac death in young athletes is
very rare. About 100 such deaths are
reported in the United States per year.
The chance of sudden death occurring
to any individual high school athlete is
about one in 200,000 per year.
Sudden cardiac death is more
common: in males than in females;
in football and basketball than in
other sports; and in African-Americans than
in other races and ethnic groups.
What are the most common causes?
Research suggests that the main cause is a
loss of proper heart rhythm, causing the
heart to quiver instead of pumping
blood to the brain and body. This is called
ventricular fibrillation (ven- TRICK-you-lar fibroo-LAY-shun). The problem is usually caused
by one of several cardiovascular abnormalities
and electrical diseases of the heart that go
unnoticed in healthy-appearing athletes.
The most common cause of sudden death in
an athlete is hypertrophic cardiomyopathy
(hi-per-TRO-fic CAR- dee-oh-my-OP-a-thee)
also called HCM. HCM is a disease of the heart,
with abnormal thickening of the heart
muscle, which can cause serious heart rhythm
problems and blockages to blood flow. This
genetic disease runs in families and usually
develops gradually over many years.
The second most likely cause is congenital
(con-JEN-it-al) (i.e., present from birth)
abnormalities of the coronary
arteries. This means that these
blood vessels are connected to
the main blood vessel of the
heart in an abnormal way. This
differs from blockages that may
occur when people get older
(commonly called “coronary artery
disease,” which may lead to a heart
attack).
S U D D E N C A R D I A C D E AT H I N Y O U N G AT H L E T E S
Other diseases of the heart that can lead to
sudden death in young people include:
●
Myocarditis (my-oh-car-DIE-tis), an acute
inflammation of the heart muscle (usually
due to a virus).
●
Dilated cardiomyopathy, an enlargement
of the heart for unknown reasons.
●
Long QT syndrome and other electrical
abnormalities of the heart which cause
abnormal fast heart rhythms that can also
run in families.
●
Marfan syndrome, an inherited disorder
that affects heart valves, walls of major
arteries, eyes and the skeleton. It is
generally seen in unusually tall athletes,
especially if being tall is not common in
other family members.
Are there warning signs to watch for?
In more than a third of these sudden cardiac
deaths, there were warning signs that were
not reported or taken seriously. Warning
signs are:
●
Fainting, a seizure or convulsions during
physical activity;
●
Fainting or a seizure from emotional
excitement, emotional distress or being
startled;
●
Dizziness or lightheadedness, especially
during exertion;
●
Chest pains, at rest or during exertion;
●
Palpitations - awareness of the heart
beating unusually (skipping, irregular or
extra beats) during athletics or during cool
down periods after athletic participation;
●
Fatigue or tiring more quickly than peers; or
●
Being unable to keep up with friends due
to shortness of breath (labored breathing).
What are the current recommendations
for screening young athletes?
New Jersey requires all school athletes to be
examined by their primary care physician
(“medical home”) or school physician at least
once per year. The New Jersey Department of
Education requires use of the specific Preparticipation Physical Examination Form (PPE).
This process begins with the parents and
student-athletes answering questions about
symptoms during exercise (such as chest
pain, dizziness, fainting, palpitations or
shortness of breath); and questions about
family health history.
The primary healthcare provider needs to
know if any family member died suddenly
during physical activity or during a seizure.
They also need to know if anyone in the
family under the age of 50 had an
unexplained sudden death such as
drowning or car accidents. This information
must be provided annually for each exam
because it is so essential to identify those at
risk for sudden cardiac death.
PPE. However, these procedures may be
expensive and are not currently advised by
the American Academy of Pediatrics and the
American College of Cardiology unless the
PPE reveals an indication for these tests. In
addition to the expense, other limitations of
technology-based tests include the
possibility of “false positives” which leads to
unnecessary stress for the student and
parent or guardian as well as unnecessary
restriction from athletic participation.
The United States Department of Health
and Human Services offers risk assessment
options under the Surgeon General’s Family
History Initiative available at
http://www.hhs.gov/familyhistory/index.html.
When should a student athlete see a
heart specialist?
The required physical exam includes
measurement of blood pressure and a careful
listening examination of the heart, especially
for murmurs and rhythm abnormalities. If
there are no warning signs reported on the
health history and no abnormalities
discovered on exam, no further evaluation or
testing is recommended.
If the primary healthcare provider or school
physician has concerns, a referral to a child
heart specialist, a pediatric cardiologist, is
recommended. This specialist will perform
a more thorough evaluation, including an
electrocardiogram (ECG), which is a graph of
the electrical activity of the heart. An
echocardiogram, which is an ultrasound test
to allow for direct visualization of the heart
structure, will likely also be done. The
specialist may also order a treadmill exercise
test and a monitor to enable a longer
recording of the heart rhythm. None of the
testing is invasive or uncomfortable.
Are there options privately available to
screen for cardiac conditions?
Can sudden cardiac death be prevented
just through proper screening?
Technology-based screening programs
including a 12-lead electrocardiogram (ECG)
and echocardiogram (ECHO) are
noninvasive and painless options parents
may consider in addition to the required
A proper evaluation should find most, but not
all, conditions that would cause sudden death
in the athlete. This is because some diseases
are difficult to uncover and may only develop
later in life. Others can develop following a
normal screening evaluation, such as an
infection of the heart muscle from a virus.
This is why screening evaluations and a
review of the family health history need to
be performed on a yearly basis by the
athlete’s primary healthcare provider. With
proper screening and evaluation, most cases
can be identified and prevented.
Why have an AED on site during sporting
events?
The only effective treatment for ventricular
fibrillation is immediate use of an automated
external defibrillator (AED). An AED can
restore the heart back into a normal rhythm.
An AED is also life-saving for ventricular
fibrillation caused by a blow to the chest over
the heart (commotio cordis).
N.J.S.A. 18A:40-41a through c, known as
“Janet’s Law,” requires that at any schoolsponsored athletic event or team practice in
New Jersey public and nonpublic schools
including any of grades K through 12, the
following must be available:
● An AED in an unlocked location on school
property within a reasonable proximity to
the athletic field or gymnasium; and
● A team coach, licensed athletic trainer, or
other designated staff member if there is no
coach or licensed athletic trainer present,
certified in cardiopulmonary resuscitation
(CPR) and the use of the AED; or
● A State-certified emergency services
provider or other certified first responder.
The American Academy of Pediatrics
recommends the AED should be placed in
central location that is accessible and ideally
no more than a 1 to 11/2 minute walk from any
location and that a call is made to activate 911
emergency system while the AED is being
retrieved.
160 Main Street
Phone: 973-593-3149
Mary Jane Skordinsky, CSN
Fax: 973-966-1908
The Board of Education recognizes child and adolescent obesity has reached epidemic levels in the United States.
Poor diet combined with the lack of physical activity negatively impacts on pupils’ health and their ability and
motivation to learn (BOE Policy #8505). Keeping this in mind, Madison Junior School will be following the food
guidelines listed below.
1. All snacks/beverages will be nut, tree nut and peanut free.

All snack/beverages for advisory or student only events will be pre-packaged by the manufacturer
with a label listing all ingredients; foods processed in a peanut, nut and tree nut facility will not be
allowed.

Home baked items are allowed when students are accompanied to an event by a parent/guardian
(i.e. 8th grade family night, band concert).
2. Food/beverages served at school celebrations or curriculum related activities shall not include:

Foods of minimal nutritional value as defined by the US Department of Agriculture regulations;
soda, water ices, chewing gum, hard candy, jellies and gums (i.e. Gum drops, jelly beans, jellied
fruit flavored slices), marshmallows, candy corn, mints, licorice, spun candy, candy coated popcorn.

All food and beverage items listing sugar, in any form, as the first ingredient.
3. All snack/beverage items sold at the school store or fundraisers shall meet the following:

No more than eight (8) grams of total fat per serving.

No more than two (2) grams of saturated fat per serving.

All beverages shall not exceed 12 ounces, with the following exceptions; water,
Milk containing 2% or less fat
Honeywell Instant Alert® for Schools
Parent User Interface
Website URL: https://instantalert.honeywell.com
Minimum Requirements
Register and create your account
1.
2.
3.
4.
5.
6.
7.
Go to the Honeywell Instant Alert for Schools website listed above.
If you are not a staff member in the school, click on ‘Parent’ in the New User box.
If you are a staff member in the school, use the user name and password given to you by the school.
Complete the student information form. Click ‘Submit.’
Complete the corresponding screen. Click ‘Submit.’
After receiving the Confirmation message, click ‘Proceed’ to get started with Instant Alert.
Note: Remember your Login Name and Password so you may use it to update your profile.
View and check details about yourself and your family members
1. Upon successful login, click on ‘My Family.’
2. Click on a parent name to view and edit parent details.
3. Click on a student name to view details about your children enrolled in this school.
Configure alert settings for yourself
1. Click on ‘Alert Setup.’
2. Click on the check boxes to select which alert type you would like to have sent to which device. Click on
‘Save’ when complete.
3. If you would like to add another contact device, select the device type and enter the device details.
Select the person to whom the device belongs and click on ‘Add.’
4. For e-mail, text messaging and pagers you may send yourself a test message. Click on ‘Send Test
Message’ to send yourself a message.
Additional Functions
View History of Alerts
Click on ‘Alert History’ to view Alerts that have been sent to you. Use the calendar icons and ‘Alert Type’ list
to filter the Alerts.
Identify key contacts for your children
1. Click on ‘Other Contacts.’
2. Click on ‘Add New Contact’ and complete the form.
3. Click on the ‘Pick Up Rights’ check box if you wish to allow this person the right to pick up your child from
school. This person’s name will appear on a report for the school.
4. Click on ‘Save’ when complete.
5. If you would like this person to receive Alerts from the school, return to the ‘Alert Setup’ page to
configure this person’s alert settings.
For Assistance: https://instantalert.honeywell.com
Click on the Help Request link in the lower right hand side of the page
Be sure to set your e-mail spam filter to receive e-mail from Honeywell.com.
Honeywell Instant Alert ® for Schools will not sell, rent, loan, trade, or lease any personal information of our members, the children
for whom they have responsibility, or others listed as contacts in the system. We will use the utmost care in protecting the privacy
and security of your information.
Alerta Instante Honeywell ® para las Escuelas
Interfaz de usuario de Padres
________________________________________________________________
URL del sitio web : https://instantalert.honeywell.com
Requerimientos Mínimos
Registrarse y crear su cuenta
1 . Vaya al sitio web para Alerta Instante Honeywell para Escuelas que aparece arriba.
2 . Si usted no trabaja en la escuela, haga clic en 'Parent' en el cuadro New User.
3 . Si usted trabaja en la escuela, use el nombre de usuario y la contraseña que ha recibido de la escuela.
4 . Complete el formulario de información del estudiante. Haga clic en 'Submit.’
5 . Complete la pantalla correspondiente. Haga clic en 'Submit.’
6 . Después de recibir el mensaje de confirmación, haga clic en 'Proceed' para empezar con Instant Alert.
7. Nota: Recuerde que su identificador y contraseña así que usted puede utilizarlo para actualizar su perfil.
Ver para revisar detalles acerca de usted y su familia
1 . Al iniciar la sesión correctamente, haga clic en 'My Family.’
2 . Haga clic en el nombre de los padres para ver y editar detalles de los padres.
3 . Haga clic en el nombre del estudiante para ver los detalles sobre sus hijos matriculados en esta escuela .
Configurar sus valores de alerta
1 . Haga clic en ‘Alert Setup.’
2 . Haga clic en las casillas de verificación para seleccionar el tipo de alerta que le gustaría haber enviado a cada
aparato. Haga clic en ‘Save’ cuando haya terminado.
3 . Si desea añadir otro aparato de contacto, seleccione el tipo de aparato y entre los detalles del aparato.
Seleccione a la persona a la que pertenece el aparato y haga clic en ‘Add.’
4 . Para el e -mail, mensajes de texto y los buscapersonas, usted puede enviar un mensaje de prueba. Haga clic en
‘Send Test Message' para enviarse un mensaje de prueba.
Funciones Adicionales
Ver el historial de las alertas
Haga clic en ‘Alert History' para ver las alertas que se han enviado a usted. Utilice los iconos del calendario y la
lista 'Alert Type’ para filtrar las alertas.
Identificar los contactos claves para sus hijos
1 . Haga clic en ‘Other Contacts.’
2 . Haga clic en ‘Add New Contact’ y complete el formulario.
3 . Haga clic en la casilla de verificación ' Pick Up Rights’ de si desea permitir que esta persona tenga el derecho a
recoger a su hijo de la escuela. El nombre de esta persona aparecerá en un informe para la escuela.
4 . Haga clic en ‘Save’ cuando haya terminado.
5 . Si desea que esta persona reciba alertas de la escuela, regrese a la página ‘Alert Setup’ para configurar los
ajustes de alerta de esta persona.
____________________________________________________________________________________________
Para Asistencia : https://instantalert.honeywell.com
Haga clic en el enlace de ‘Help Request’ en el lado inferior derecho de la página.
Asegúrese de ajustar el filtro de spam de correo electrónico para recibir correo electrónico de Honeywell.com.
____________________________________________________________________________________________
Honeywell Instant Alert para las Escuelas no venderá, alquilará, prestará, ni arrendará ninguna información personal de nuestros miembros, ni
de los niños para quienes tienen la responsabilidad, ni de otros que figuran como contactos en el sistema. Vamos a utilizar el máximo cuidado
en la protección de la privacidad y la seguridad de su información.
Madison Public Schools E-Communication
Are You Signed Up?
School Website E-Alerts are e-mails sent to you by the school to
provide information about emergency closings, special events,
curriculum news, PTO news and other timely information.
Each E-alert contains information related to a specific website
page, and is sent to people who subscribe to that particular page.
To receive the e-mails, you must register for the website AND
subscribe to e-alerts.
Recommended subscriptions:
•
•
•
Madison Public Schools Home Page
(emergency closing information is sent from this page)
Home Page for each school where you have a child attending
Any other pages of interest
Visit: http://www.madisonpublicschools.org/mps-alerts for:
• Step-by-step instructions
• Answers to Frequently Asked questions
Madison Public Schools E-Alerts
Frequently Asked Questions
What’s the first step I should take to receive school e-alerts?
Register for an account. To get started, click the Register button at the top of the screen from any page int
eh website and follow the instructions. Once you have registered, you still need to subscribe to ealerts to receive e-mails. For step by step instructions, visit
www.madisonpublicschools.org/mps-alerts.
Why do I need to provide my birthday to create an account?
The third-party provider for the district web platform, Schoolwires, requires this step to ensure that
subscribers are 18 or older. Your birthday is not recorded by Schoolwires or Madison schools.
How do I subscribe to e-alerts once I have an account?
1. Click Sign In
2. Click My Account
3. Click Edit Account Settings
4. Click Subscriptions
5. Click Manage Subscriptions
6. Under the Homepages and Calendars Tab put a check in the box next to the schools you would like to
receive homepage and calendar alerts from.
7. On the Other Areas of Interest tab choose the school and pages that you would like to receive alerts
from.
8. Note: You now have the option of receiving E-Alert text messages. If you would like to take advantage
of this feature please follow steps 1-3 above and then click E-Alert Settings.
Each e-alert contains information related to a specific web page, and is sent to people who subscribe to that
particular page, and the Edit My Subscriptions feature allows you to select the pages of most interest to
you. The first screen will give you subscription options for the district. Use the drop down menu to access
options for each specific school. You can change your subscription list at any time.
What pages should I subscribe to?
Every parent/family should subscribe to:
•
•
•
Madison Public Schools Home Page, used for emergency closing and other district-wide messages
The Home Page for each school where you have a child attending. (Use the drop down menu)
Any other pages that interest you.
How will I recognize e-alerts from the school?
The “From” line on the e-mails is: Schoolwires E-Alert System.
Will I get e-alerts from every page where I subscribe (e.g. teachers, clubs, PTO)?
Probably not. The person or group managing that page may not send e-alerts since it is not a guaranteed
way to reach everyone. Check individual web pages for updated information throughout the year.
I’m a High School parent and I want to receive Guidance E-mails by Class Year or Athletics Team
Schedule Change E-Mails. How do I sign up?
There are different registration steps for these subscriptions. Visit www.madisonpublicschools.org/mhsalerts for more information and registration tip sheets.
20
Parent Resource Information Card
Madison Junior School is interested in expanding our partnership with parents, including having
parents share their area of expertise with students – particularly where it ties into our curriculum.
Please let us know if you are interested in contributing.
Parents’ Name__________________ Child’s Name______________ Grade _________
Area of expertise __________________________________________________________
_________________________________________________________________________
Are you willing to share this information with students outside of your own child’s class? yes/no
Are you willing to mentor another student who shares this interest? yes/no
Are there other ways that you are willing to volunteer or contribute to the school? Please explain
_______________________________________________________________________
_______________________________________________________________________
Please note, this information will be shared with the faculty, and you will be contacted if we are able to use
your contribution.
21
MJS PTO 2014-2015
Welcome to the MJS PTO! Through your generosity, the PTO helps
make possible all of the educational, cultural, and social events at
MJS. Thank you for your support of our teachers and kids.
Parent name: ____________________________________
MJS Children:_____________________________________
PTO annual dues
(covers dues, required team t-shirts, & one family directory)
$30
____________
Additional copies of directory @ $5 ___ x $ 5
____________
I would like to make an additional
donation to support MJS activities
$ ____________
Total amount enclosed:
$_____________
Circle one:
Cash
PayPal
Check (made payable to MJS PTO)
To Pay Using PAYPAL:
Visit the MJS Web site, PTO Tab, Click on the PayPal button.
PLEASE RETURN WITH CHILD TO ADVISORY IN ENVELOPE MARKED
"PTO DUES”
Questions? Contact: [email protected] or 973-377-4050.
22
MJS Parent Volunteer Opportunities
There are many opportunities to get involved at MJS and we appreciate
your willingness to help make the events for students and teachers so
memorable!
Please circle your areas of interest:
6th Grade Social (Oct)
-Donate food/beverages
-Chaperone
Teambuilding Day (Nov)
-Help out at event
7th/8th Grade Halloween Dance
-Set up
-Chaperone
-Clean up
6th/7th/8th Gr. Winter Dance (Feb)
-Set up
-Chaperone
-Clean up
Hospitality
(for various school/teacher events)
-Set up
-Clean up
-Bake/cook
-Donate
Beautification
-Containers at entrance
-Plant/Weed courtyard
8th Grade Dance
-Set up
-Clean up
-Order food
-Chaperone
8th Grade Breakfast
-Set up
-Clean up
-Bake
-Order food
-Chaperone
8th Grade Promotion
-Organize caps/gowns
-Set up
Office help
-Copying, stuffing, typing
Adult Social
-Many volunteers needed for variety
of tasks!
NAME:_____________________________________________
PHONE:____________________________________________
EMAIL:_____________________________________________
CHILD’SGRADE(S):___________________________________
WELCOME TO THE 2014-2015 STOP & SHOP
A+ SCHOOL REWARDS PROGRAM
MADISON JUNIOR SCHOOL – ID# 06815
Dear Parents:
Welcome to the start of a new school year and a year of A+ School Rewards. Starting
October 3, 2014 through March 19, 2015 Madison Junior School will have the opportunity to
earn cash through Stop & Shop A+ School Rewards Program.
All you have to do is:
Log on to www.stopandshop.com/aplus select CUSTOMER REGISTRATION to register
online using your Stop & Shop Card.
IT’S THAT EASY!!
NEW THIS YEAR: If you registered your card last year, you DO NOT need to re-register this year.
You can visit the website to verify correct school assignment.
Also, don’t forget to
encourage your friends and relatives to do the same. It could mean more cash for our
school.
After you register your card, each shopping trip at Stop & Shop using your Stop & Shop Card
earns CASH for our school. Each month, the amount of CASH awarded will be updated on
the Stop & Shop website. You can track the amount of points you earn for our school by
checking
your
grocery
receipt
and
online
when
you
create
an
account
at
www.stopandshop.com. Our school will receive a check at the end of the program. The
money can be used for any of our school’s educational needs. In 2012-2013, MJS earned
over $500. Last school year, 2013-2014, MJS earned over $800. Our goal this year is to make
over $1000 for MJS just by shopping at Stop & Shop with a registered Stop & Shop card!
Madison Junior School Ticket Offer
Come Experience a Jets game this fall!!



300-level Tickets starting at $70 per ticket
Proceeds to benefit MJS PTO!
Get your school spirit on and join us for this fun event!!
VS
PITTSBURGH STEELERS VS NEW YORK JETS
SUNDAY, NOVEMBER 9, 2014 – 1:00PM*
MetLife Stadium, East Rutherford, NJ
**Subject to new Sunday Night NFL Flex Schedule, so time is TBC
To purchase tickets please follow the link below
NOTE: All sales are final and non-refundable. Tickets must be purchased online and in advance and will not be available on day of game.
TO ACCESS THIS PROMOTION, USE THE LINK BELOW AND ENTER THE CODE:
Madison14
http://bit.ly/jetsmjs
(depending on your browser, you may need to cut and past the above
address into your address bar)
For more information, please contact:
Margie Ticknor at [email protected]
25
170 Ridgedale Avenue Madison, NJ 07940
Dear Parent:
We are still the MMA! We want to share with you our new name and logo. It better
reflects our expanded efforts on behalf of all school arts programs, for all ages.
Madison Music and Arts is the only parent group soley dedicated to supporting theater,
visual arts, and all types of music-making – both curricular and extracurricular activities throughout our school district, K-12.
What do we do?

Provide grant funding for items critical to the arts curriculum: instruments, pilot
programs, art supplies, production costs, etc. We are excited to partner with
local businesses to seed a new Art Club at the high school this fall.

Showcase student artists and performers: our partnership with the Downtown
Development Commission and the Madison Arts and Cultural Association
resulted in ‘Sidewalk Sounds’, a new weekly music series this summer in
downtown Madison.

Advocate for the importance of music and arts curriculum with our parents,
administration, and the Board of Education. This fall we are realizing a longdesired goal of restoring our district music staff to the levels of 2007.
Your $20 family membership is the best way for you to support our efforts and for us to
keep you in the loop about all the latest Arts news in our school district.
Please join us by becoming a member, volunteering for an event, and learning more
through our website at www.madisonpublicschools.org/mma or “Madison Music and
Arts” on Facebook.
Thank you for your support!
Helen Raymaker, President, [email protected]
Jennifer McCulloch, Secretary
John Gribble, Treasurer
Jaime Conroy, At Large
Johanna Habib – At Large
Sheryl Keane – At Large
Mary McManus, Membership
The Madison Music Association is a 501 (C) 3 non-profit organization. Tax ID# 22-3405904
8/5/2014 12:01 PM
25
2014-2015 MMA MEMBERSHIP AND VOLUNTEER FORM
Family Name ________________________ Address______________________________
Email____________________________________________
I have students attending:
___CAS
___KRS
___TJS
___MJS
Dues Payment
$20 annual dues per family ________
Additional donation
________
Total
________
___MHS
___Alumni Parent
Please make checks payable to: MMA
Thank You!
Receipt requested ______ (√ if req’d)
Please return this form along with dues in an envelope marked Madison Music and Arts to your
child’s school main office, or mail to:
Mary McManus
6 Fairview Ave.
Madison, NJ 07940
The Madison Music Association is a 501 (C) 3 non-profit organization. Tax ID# 22-3405904
VOLUNTEER OPPORTUNITIES:
MHS Art Club
___ Join MHS students who are launching a new Art Club
Fruit Sale (Dec 15) – MMA'S largest fundraiser
___Phone reminders
___Pick up day
Dessert and Jazz (February 28) – MHS/MJS musicians perform
___Baker
___Volunteer
The Arts Matter (April 1) – annual faculty concert and exhibition
___Volunteer
District MJS/MHS Festivals: Choral (February 4), Band (April 16), String (April 23)
___Volunteer (please specify which group) _____________________________________
Student performance opportunities: Bottle Hill Day, Coffeehouses, etc.
___Volunteer
Publicity - Assist in spreading word of events and activities.
___Volunteer
______General Volunteer – Call me if you need help! Phone: _____________
8/5/2014 12:01 PM
26
Playwrights Theatre
PO Box 1295
Madison, NJ 07940
973-514-1787
973-514-2060 (fax)
Summer 2014
“Children want to write. They want to write the first day they attend school. This is no accident. Before they went
to school they marked up walls, pavements, newspapers with crayons, chalk, pens or pencils… anything that
makes a mark. The child’s marks say, ‘I am.’”
from Writing: Children and Teachers at Work by Donald Graves, 1983, p. 3
Since 1986, Playwrights Theatre of New Jersey (PTNJ) has fostered the creative imaginations and voices of Madison’s
youngest writers through the Madison Young Playwrights Program (MYPP). For the 29th consecutive year, the MYPP
will work with students in grades 6-8 to develop original one-act plays. Students who enroll in the program will meet
after school, once a week for ten (10) weeks, and work under the guidance of a professional teaching artist from PTNJ.
Class time involves creative writing, improvisation and revision. This is NOT an acting program.
Student-written plays will be collected and read by PTNJ staff in late December. Up to three (3) plays from each school
may be chosen for presentation during the Madison Festival in March 2015 when a company of actors from Playwrights
Theatre will perform revised plays at the playwrights’ schools.
Additionally, scripts completed and submitted for the Madison program are also entered into the NJ Young Playwrights
Festival, a statewide competition organized by Playwrights Theatre. In past years, Madison students had their plays
selected for this statewide honor. More information on the next Contest/Festival is available online at www.njypf.org.
Playwriting classes will be held at Madison Junior School on Tuesdays from 3:00-4:30 pm beginning October 7 and
ending December 16 (no class on November 4).
Please make note of this schedule when choosing to register your child for the program.
There are two ways to register your child:
1) Complete the online application located at https://www.surveymonkey.com/s/MadisonYoungPlaywrights2014
2) You may also complete and return the Application Form attached to, or located on the back of, this memo to the
Main Office at your child’s school.
Registrations must be received no later than Wednesday, September 24th. The first 20 students will be selected for the
program. You will receive confirmation from Playwrights Theatre of your child’s participation in the program.
The Madison Young Playwrights Program is offered to Madison school students free of charge! We look forward to
working with you and your child during an exciting year of fun and creativity. Please contact the Education office at PTNJ
with any questions – 973-514-1787, ext. 21 or [email protected].
26
P.O. Box 1295
Madison, NJ 07940
973-514-1787, x.21
973-514-2060
www.ptnj.org
Playwrights Theatre’s
Madison Young Playwrights Program
After-School Playwriting
Thank you for your interest in the 29th annual Madison Young Playwrights Program. Classes will be held at each individual school on Tuesdays beginning October 7 and ending December 16 (no classes on November 4) and according to the
times printed on the opposite site of this form. Please be sure to write down the dates and times of your child’s program.
This program is offered to students in grades 4, 5, 6, 7, and 8. If you wish to enroll, complete and return the following
form to the Main Office at your child’s school. Registration forms must be received no later than Wednesday, September 24. You may also register online at https://www.surveymonkey.com/s/MadisonYoungPlaywrights2014
Class size is limited; only 20 students will be accepted on a first-come, first-served basis. Enjoy!
Madison Young Playwrights Program
Playwriting Class Application Form
Registration Form
PLEASE PRINT CLEARLY
Student Name
Grade
Parent/Guardian Name
Address
Phone Number
Parent Email Address
My child has permission to walk
home from school.
Child’s School
Has your child participated in the program before?
YES
The safety of your child is important. We cannot allow a child to
walk home without your consent.
Circle YES if your child will walk
home from class EVERYDAY. If
you circle NO, your child will not
be allowed to walk home without a
written letter of permission. Thank
you.
NO
I give permission for my
child to be photographed for
program documentation and
publicity.
YES NO
YES
NO
I give permission for my child to participate in the 10-week playwriting workshop. I understand participants will be
expected to attend every class, complete program assignments and be dismissed at the time indicated on the front of
this page. I will arrange for prompt transportation.
I want to participate in the playwriting workshop offered by Playwrights Theatre for ten (10) weeks in the fall during
after-school hours. I understand that I will be expected to attend every class and complete all assignments.
Student Signature
27
Let us think of education as the
means of developing our greatest
abilities because in each of us
there is a private hope and dream
which, fulfilled, can be translated
into a benefit for everyone and
greater strength for our nation.
Madison
PPEC
John F. Kennedy
Madison
Parents and
Professionals
for Exceptional
Children
Volunteer Opportunities:
Madison PPEC has the following volunteer
opportunities:

Communication and Public
Relations

Fundraising/Grants

Meeting Topics and Programs

Discussion/Support Groups

Acceptance/Awareness
Education

General “you can count on me”
Volunteer
Madison Parents and Professionals for
Exceptional Children
E-Mail: [email protected]
Website: www.madisonpublicschools.org
Let us
Excellence for All
Children
27
Who We Are
The Madison PPEC is a non-profit
P.T.O. dedicated to the lives of
children with special needs and
their families:

To provide support and
advocacy for families with
children who have special
needs.

To develop more effective
communication between
parents and special services
personnel in the schools

To provide programs and
information for parents and
professionals on current topics
in special education

To improve the educational,
recreational, vocational and
social programs for our
children

To keep abreast of federal,
state and local legislation that
may affect the education of
exceptional children
By working together with the
Special Services Department, we
can help our children grow, and
help the community to better
understand the special needs of
our children.
What We Do
PARENT DISCUSSION GROUPS
These groups, one for each of the
school levels – pre-school,
elementary, middle school, high
school and out-of-district, offer
parents an opportunity to network
and to share ideas and experiences.
TOPIC PRESENTATIONS
All are welcome to attend these
meetings. Presentations featuring
guest speakers are conducted at the
Madison Schools on topics that are
especially pertinent to special needs
children and their families. As an
affiliate of the United Leadership
Council for Exceptional Children,
the Madison PPEC also provides
information on presentations offered
in neighboring communities.
Join Us
PPEC MEMBERSHIP FORM
2014-2015 School Year
Membership is open to all parents,
teachers, professionals and
community members who are
interested in the lives and education
of children with special needs.
Please complete this form, enclose $10
per family, and return to: Madison
PPEC, c/o Madison School District,
Department of Special Services, 170
Ridgedale Avenue, Madison, N.J.
07940. Please make checks payable to
Madison PPEC. Tax deductable
donations are also accepted. Thank
you for your support.
Name: __________________________
Address: _______________________
Telephone: _____________________
Cell: ___________________________
Email: __________________________
INFORMATION RESOURCES
Information on local, state and
federal resources is available
through the PPEC.
Grade Level(s):__________________
School(s): ______________________
Please _____ include _____ do not include
my name in a parent directory. This
information will only be used for
communicating within the PPEC and will
not be shared with anyone else.
27
Madison Parents and Professionals for Exceptional Children (PPEC)
2014-2015 Membership Form
Please complete this form, enclose $10 per family, and return it to: Madison PPEC, c/o Madison School
District, Department of Special Services, 170 Ridgedale Avenue, Madison, NJ 07940. Please make checks
payable to Madison PPEC. Thank you for your support.
Name:
Address:
Telephone:
Cell:
_
Email:
Grade Level (s)
_
Name of School or “out of district”:
$
$
$
10.00
_
Dues
Additional Tax Deductible Donation
Total
Please
include
do not include my name in a parent directory. This information will be
used for the sole purpose of communicating among the members of the Madison PPEC and will NOT be
shared with any other person or group. If you have any questions, please contact Michelle Goodwin, Sharon
Purse, Karin Szotak or Sue Whitehorn at [email protected].
Volunteer Opportunities:
We appreciate your financial support, but your involvement with activities and meetings would enhance the
programs we can offer and the services that are provided for the exceptional children that our district serves.
Please indicate below those areas in which you would like to become involved.

Communication and Public Relations (Newsletters, website, etc…)

Fundraising/Grants

Meeting Topics and Programs (Please list topics of interest.)
_
_

Discussion/Support Groups (Please indicate specific areas of interest such as, ADHD, LD,
etc.)

_
Acceptance/Awareness Education (Promoting acceptance/awareness programs, training
staff, researching resource materials for a special needs library)

General “you can count on me” Volunteer
Please join our organization! The greater our numbers, the greater will be our ability to support the
needs of our special children. We look forward to seeing you at our next meeting.
The 2014-2015 PPEC Executive Team,
Michelle Goodwin, Sharon Purce, Karin Szotak, and Sue Whitehorn
29
29
29
29
29
29
29
29
29
29
29
29
Board Approved 4/8/2014
M
1
8
15
22
29
September (18,20)
T
W
T
2
3
4
9
10
11
16
17
18
23
24
25
30
6
13
20
27
October (23)
T
W
T
1
2
7
8
9
14
15
16
21
22
23
28
29
30
M
3
10
17
24
November (16)
T
W
T
4
5
6
11
12
13
18
19
20
25
26
27
M
1
8
15
22
29
December (17)
T
W
T
2
3
4
9
10
11
16
17
18
23
24
25
30
31
M
M
5
12
19
26
January (20)
T
W
T
1
6
7
8
13
14
15
20
21
22
27
28
29
MADISON PUBLIC SCHOOLS
2014-15 SCHOOL CALENDAR
F
5
12
19
26
F
3
10
17
24
31
F
7
14
21
28
F
5
12
19
26
September
1
Labor Day – Schools Closed
2-3
Staff In-Service
4
Classes Commence
25
Rosh Hashanah – Schools Closed
October
13
Columbus Day – Early Dismissal
& afternoon Staff In-Service
23
2 Hr Delayed Opening
November
3-4
Early Dismissal: Elem & JS
Parent/Teacher Conferences
6-7
NJEA Convention – Schools
Closed
26
Early Dismissal/Thanksgiving
27-28 Thanksgiving Recess
December
11
23
Early Dismissal
24-31 Holiday Recess
January
1,2
Holiday Recess
5
Classes Resume
February
5
13-17 President’s Day/Winter Break
March
19
April
3
Good Friday
6-10 Spring Recess
13
Classes Resume
27-28 Early Dismissal: Elem & JS
Parent/Teacher Conferences
May
22
Staff In-Service
25
Memorial Day – School Closed
June
19
Final Day - Early Dismissal
22
F
2
9
16
23
30
-
M
2
9
16
23
February (17)
T
W
T
3
4
5
10
11
12
17
18
19
24
25
26
M
2
9
16
23
30
March (22)
T
W
T
3
4
5
10
11
12
17
18
19
24
25
26
31
F
6
13
20
27
6
13
20
27
April (16)
T
W
T
1
2
7
8
9
14
15
16
21
22
23
28
29
30
F
3
10
17
24
M
May (19,20)
T
W
T
4
11
18
25
5
12
19
26
M
1
8
15
22
29
June (15,16)
T
W
T
2
3
4
9
10
11
16
17
18
23
24
25
30
M
Staff In-Service
Legend
Total School Days
Schools Closed
Student Days 183
Early Dismissal
Teacher Days 187
In-Service Day (Staff Only)
2Hr Delayed Opening (In-Service)
School Closed if 3 snow days are
not used
6
13
20
27
7
14
21
28
Note: There are up to three snow days built into this calendar. In the event that inclement weather forces additional
school closings, those extra day(s) will be made up beginning with May 22, April 10,9,8,7,6.
F
6
13
20
27
F
1
8
15
22
29
F
5
12
19
26
Board Approved 4/8/2014
Septiembre (18,20)
L
M
M
J
1
2
3
4
8
9
10
11
15
16
17
18
22
23
24
25
29
30
L
6
13
20
27
Octubre (23)
M
M
J
1
2
7
8
9
14
15
16
21
22
23
28
29
30
L
3
10
17
24
Noviembre (16)
M
M
J
4
5
6
11
12
13
18
19
20
25
26
27
L
1
8
15
22
29
Diciembre (17)
M
M
J
2
3
4
9
10
11
16
17
18
23
24
25
30
31
L
5
12
19
26
Enero (20)
M
M
J
1
6
7
8
13
14
15
20
21
22
27
28
29
V
5
12
19
26
V
3
10
17
24
31
V
7
14
21
28
V
5
12
19
26
V
2
9
16
23
30
MADISON PUBLIC SCHOOLS
2014-15 SCHOOL CALENDAR
Nota: Hay 3 días de nieve
Septiembre
1
Labor Day incl
– No hay clases
2-3
El personal en talleres
4
Clases empiezan
25
Rosh Hashanah – No hay clases
Octubre
13
Columbus Day – Salida temprano;
Personal en talleres por la tarde
23
Se abre 2 horas retardadas
Noviembre
3-4
Salida temprano: Elem & JS
Conferencias Padres/Maestros
6-7
NJEA Convención – No hay clases
26
Salida temprano /Thanksgiving
27-28 Thanksgiving. No hay clases
Diciembre
11
23
Salida temprano
24-31 Vacaciones
Enero
1,2
Vacaciones
5
Clases recomienzan
Febrero
5
13-17 President’s Day/Vacaciones
Marzo
19
Abril
3
Viernes Santo
6-10 Vacaciones
13
Clases recomienzan
27-28 Salida temprano: Elem & JS
Conferencias Padres/Maestros
Mayo
22
25
Memorial Day – No hay clases
June
19
Día final – Salida temprano
22
Días en Total:
Días escolares 183
Para Maestros 187
-
Clave
No hay clases
Salida temprano
Personal en talleres (no hay clases)
Se abre 2 horas retardadas (talleres)
No hay clases si no se usan 3 días
de nieve
L
2
9
16
23
Febrero (17)
M
M
J
3
4
5
10
11
12
17
18
19
24
25
26
L
2
9
16
23
30
Marzo (22)
M
M
J
3
4
5
10
11
12
17
18
19
24
25
26
31
V
6
13
20
27
6
13
20
27
Abril (16)
M
M
J
1
2
7
8
9
14
15
16
21
22
23
28
29
30
V
3
10
17
24
L
Mayo (19,20)
M
M
J
4
11
18
25
5
12
19
26
L
1
8
15
22
29
Junio (15,16)
M
M
J
2
3
4
9
10
11
16
17
18
23
24
25
30
L
6
13
20
27
7
14
21
28
V
6
13
20
27
V
1
8
15
22
29
V
5
12
19
26
Nota: Este calendario incluye 3 días de nieve. Si, por razones de tiempo, hay que cerrar la escuela más de 3 días, los días
adicionales empiezan con el 22 de mayo, y el 10,9,8,7,6 de abril.
MADISON JUNIOR SCHOOL CALENDAR 2014-2015
Note: All dates are subject to change
August 28
September 4
September 16
September 17
September 19
September
September 25
Thursday
Thursday
Tuesday
Wednesday
Friday
tbd
Thursday
MJS Tours
First Day of School
Picture Day
Peer Leader Retreat
Play 60 Kick off
Schools Closed (Rosh Hashanah)
9:00am-11:00am
October 1
October 6-10
October 9
October 10
October 13
October 15
October 16
October
October 24
October 29
Wednesday
Mon-Fri
Thursday
Friday
Monday
Wednesday
Thursday
tbd
Friday
Wednesday
Peer Connections Kickoff
Spirit Week
6th Grade Social
Coffee with the MJS Administration
Single Session (Staff In-Service)
PTO Meeting
Student Volleyball Tournament (Spike For The Cure)
Play 60 Wrap up (tentative date)
7th & 8th Grade Halloween Dance
Picture Make-ups
November 3-4
November 6-7
November 14
November 15
November 16
November 20
November 26
November 26
November 27-28
Mon-Tue
Thur-Fri
Friday
Saturday
Sunday
Thursday
Wednesday
Wednesday
Thur-Fri
Single Session (Conferences)
Schools Closed (NJEA Convention)
MJS Musical Production
MJS Musical Production
MJS Musical Production (snow date)
6th, 7th & 8th Grade Team Building Day
Single Session
Schools Closed (Thanksgiving)
December 10
December 11
December 11
December 17
December 19
December 23
Dec. 24-Jan. 2
Wednesday
Thursday
Thursday
Wednesday
Friday
Tuesday
Wed - Fri
PTO Meeting
2 Hour Delayed Opening
Orchestra/Chorus Winter Concert
Band Winter Concert
Holiday Assembly
Single Session
Schools Closed (Holiday Recess)
7:30pm
9:55am
7:30pm
7:30pm
February 5
February 13-17
February 20
February 23-27
February 25
Thursday
Fri-Tue
Friday
Mon-Fri
Wednesday
Schools Closed (Winter Break)
6th, 7Th & 8th Grade Social and Dance
Book Fair
PTO Meeting
9:55am
March 6
March 7
March 8
March 13
March 19
March 25
Friday
Saturday
Sunday
Friday
Thursday
Wednesday
MJS Play Production
MJS Play Production
MJS Play Production (snow date)
Staff v. Student Basketball Game
All City Band/Orchestra Concert
April 3
April 6-10
April 15
April 15
April 27-28
Friday
Mon-Fri
Wednesday
Wednesday
Mon-Tue
Schools Closed (Good Friday)
Schools Closed (Spring Recess)
5th Grade Orientation
5th Grade Parent Orientation
Single Session (Conferences)
May 6
May 9
May 13
May 15
May 22
May 25
May 27
Wednesday
Saturday
Wednesday
Friday
Friday
Monday
Wednesday
Mr. MJS
PTO Meeting
AERSHES Kickball Fundraiser
Schools Closed (Staff In-Service)
Schools Closed (Memorial Day)
Orchestra/Chorus Spring Concert
June 3
June 12
June 12
June 17
June 18
June 18
June 19
June 19
June 19
June 22
Wednesday
Friday
Friday
Wednesday
Thursday
Thursday
Friday
Friday
Friday
Monday
Band Spring Concert (High School)
Talent Show
8th Grade Dance
8th Grade Yearbook Party
Awards Assembly
PGC Pool Party
8th Grade Breakfast
Promotion Ceremony
Last Day of School-Single Session
Staff In-Service
7:00pm-9:00pm
10:00am
3:00pm-4:30pm
9:30am
12:25pm
7:30pm
7:00pm
10:00am
7:30pm-9:30pm
12:25pm
7:30 pm
4:00 pm
2:00 pm
7:00pm
12:25pm
7:30pm-9:30pm
7:30pm
7:30pm
4:00pm
2:00 pm
7:00pm
9:55am
7:30pm
9:00-11:00am
7:00pm
12:25pm
7:00pm
7:00pm
7:30pm
3:00-6:00pm
7:30pm
7:30pm
1:00pm
7:00pm-9:30pm
1:00pm
9:30am
3:00pm-5:00pm
8:00am
10:30am
12:25pm
MADISON JUNIOR SCHOOL TIME SCHEDULE 2014-2015
MONDAY, TUESDAY, THURSDAY, FRIDAY
Staff Reports
Doors Open for Pupils
Tardy Bell*
GRADE 6
Period 1/Attendance
Period 2
Locker
Period 3
Announcements
Locker
Period 4 Lunch
Locker
Period 5
Period 6
Locker
Period 7
Period 8
GRADE 7
Period 1/Attendance
Period 2
Locker
Period 3
Announcements
Period 4
Locker
Period 5
Locker
Period 6 Lunch
Locker
Period 7
Period 8
GRADE 8
Period 1/Attendance
Period 2
Locker
Period 3
Announcements
Period 4
Locker
Period 5 Lunch
Locker
Period 6
Period 7
Locker
Period 8
7:45
7:50
7:55
7:55-8:54
8:57-9:56
(59 minutes)
(59 minutes)
10:00-10:40
10:40-10:44
(40 minutes)
(4 minutes)
10:47-11:12
(25 minutes)
11:16-12:15
12:18-12:58
(59 minutes)
(40 minutes)
1:02-2:00
2:03-2:43
(58 minutes)
(40 minutes)
7:55-8:54
8:57-9:37
(59 minutes)
(40 minutes)
9:41-10:40
10:40-10:44
10:47-11:27
(59 minutes)
(4 minutes)
(40 minutes)
11:31-12:30
(59 minutes)
12:33-12:58
(25 minutes)
1:02- 2:00
2:03 -2:43
(58 minutes)
(40 minutes)
7:55-8:35
8:38-9:37
(40 minutes)
(59 minutes)
9:41-10:40
10:40-10:44
10:47-11:27
(59 minutes)
(4 minutes)
(40 minutes)
11:30-11:55
(25 minutes)
11:59-12:58
1:01- 1:41
(59 minutes)
(40 minutes)
1:45 -2:43
(58 minutes)
*Please note: Mondays and Thursdays are “A” days, Tuesdays and Fridays are “B” days. Wednesday has its own
schedule due to advisory. The schedule is the same every week; there is no change in A, B or Wednesday schedules
due to Holidays or snow days.
**If students are tardy, a note must accompany them or a phone call must be received at 973-593-3149 ext. 3151
(roll call number) by 7:55 a.m. before student arrival from the parent or authorized guardian. In the absence of a
note or prior phone call, a student that is tardy 2 or more times will be required to remain after school for 30
minutes.
MADISON JUNIOR SCHOOL TIME SCHEDULE 2014-2015
WEDNESDAY
Staff Reports
Doors Open for Pupils
Tardy Bell*
GRADE 6
Period 1/Attendance
Period 2
Locker
Advisory
Announcements
Period 3
Locker
Period 4 Lunch
Locker
Period 5
Period 6
Locker
Period 7
Period 8
GRADE 7
Period 1/Attendance
Period 2
Locker
Advisory
Announcements
Period 3
Period 4
Locker
Period 5
Locker
Period 6 Lunch
Locker
Period 7
Period 8
GRADE 8
Period 1/Attendance
Period 2
Locker
Advisory
Announcements
Period 3
Period 4
Locker
Period 5 Lunch
Locker
Period 6
Period 7
Locker
Period 8
7:45
7:50
7:55
7:55-8:39
8:42-9:26
(44 minutes)
(44 minutes)
9:30-10:14
10:14-10:20
10:23-11:07
(44 minutes)
(6 minutes)
(44 minutes)
11:10-11:35
(25 minutes)
11:39-12:22
12:25-1:09
(43 minutes)
(44 minutes)
1:13-1:56
l:59-2:43
(43 minutes)
(44 minutes)
7:55-8:39
8:42-9:26
(44 minutes)
(44 minutes)
9:30-10:14
10:14-10:20
10:23-11:07
11:10-11:54
(44 minutes)
(6 minutes)
(44 minutes)
(44 minutes)
11:58-12:41
(43 minutes)
12:44-1:09
(25 minutes)
1:13-1:56
1:59-2:43
(43 minutes)
(44 minutes)
7:55-8:39
8:42-9:26
(44 minutes)
(44 minutes)
9:30-10:14
10:14-10:20
10:23-11:07
11:10-11:54
(44 minutes)
(6 minutes)
(44 minutes)
(44 minutes)
11:57-12:22
(25 minutes)
12:26-1:09
1:12-1:56
(43 minutes)
(44 minutes)
2:00-2:43
(43 minutes)
**If students are tardy, a note must accompany them or a phone call must be received at 973-593-3149 ext. 3151
(roll call number) by 7:55 a.m. before student arrival from the parent or authorized guardian. In the absence of a
note or prior phone call, a student that is tardy 2 or more times will be required to remain after school for 30
minutes.
MADISON JUNIOR SCHOOL
REPORT CARD SCHEDULE 2014-2015
MJS report cards will be available online for students/parents:
MP 1 September 4, 2014
November 5, 2014
November 11, 2014
First Marking Period Begins
First Marking Period Ends
Report Cards Available in Parent Portal
MP 2 November 11, 2014
January 26, 2015
January 30, 2015
Second Marking Period Begins
Second Marking Period Ends
MP 3 January 27, 2015
April 13, 2015
April 17, 2015
Third Marking Period Begins
Third Marking Period Ends
MP 4 April 14, 2015
June 19, 2015
June 25, 2015
Fourth Marking Period Begins
Fourth Marking Period Ends
Conferences:
November 3 & 4, 2014
April 27 & 28, 2015
*The administration reserves the right to adjust these dates if necessary.

Madison Junior School - Madison Public Schools

Transcripción

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