career camp - Northmont City Schools

EMERGENCY MEDICAL FORM
MVCTC
I H E R E B Y G IV E M Y C O N S E N T T O C A L L
T H E F O L L O W IN G M E D IC A L C A R E
P R O V ID E R S :
CAREER CAMP
D O C TO R : ______________________________________
JUNE 6 - 10, 2016
P H O N E :______________ __________________________
D E N TIS T: ______________________________________
9 A.M. – 11:30 A.M.
P H O N E ________________________________________
M ED IC AL SPEC IALIST: ___________________________
P H O N E : _______________________________________
P R E F E R R E D H O S P ITA L: _________________________
In the event reasonable attempts to contact me have been unsuccessful, I
hereby give my consent for the administration of any treatment deemed
necessary by the above-named doctor, or in the event the designated
preferred practitioner is not available, by another licensed physician or dentist
and the transfer of the child to any hospital reasonably accessible.
This authorization does not cover major surgery unless the medical opinions
of two other licensed physicians or dentists, concurring the necessity for such
surgery, are obtained prior to the performance of such surgery. Please list
any medications being taken and any physical impairment to which a
physician and the school should be made aware.
Is your child allergic to bees/insects? Yes_____________ No___________
Parent/Guardian Signature:__________________________
Date: __________________________________________
www.mvctc.com For more information: Mrs. Rhonda Green Miami Valley CTC 6800 Hoke Road Englewood, OH 45315 For students who will be
entering the
th
th
8 , 9 , and 10th grades
Phone 937.854.6067 rgreen@mvctc.com Fax 937.837.1594
The Miami Valley Career Technology Center is dedicated to providing equal educational opportunities and equal employment opportunities without regard to race, religion, color, national origin, ancestry, age, sex, sexual orientation, handicap, marital status, or veteran status. Date of publication
Join the fun while you
learn at this FREE
Career Exploration
Opportunity
WHAT IS
CAREER CAMP
APPLICATION
Name _________________________________________
Full Address
________________________________________________
________________________________________________
________________________________________________
CAREER CAMP?
Career Camp is a FREE one-week
exploration program designed to give
students entering eighth, ninth, and tenth
grades a hands-on experience in various
careers to help them make good career
decisions. For over 25 years, students from
our partner schools have been attending
the MVCTC Career Camp.
POSSIBLE CAREER EXPLORATION
This year’s camp will be held at the MVCTC
campus the week of June 6-10, 2016. The
camp runs from 9 am until 11:30 am each
day.
BUSINESS & INFORMATION TECHNOLOGY
To register, complete the application
form and turn it in to your guidance
counselor or mail it to Rhonda Green,
MVCTC, 6800 Hoke Road, Englewood,
OH 45315. The deadline to register is May
13, 2016. A confirmation letter will be
mailed to you prior to Career Camp.
AREAS COULD BE:
ARTS AND COMMUNICATION
AGRICULTURE/NATURAL RESOURCES
HEALTH
HUMAN RESOURCES
BUILDING & CONSTRUCTION
MECHANICAL TECHNOLOGIES
INDUSTRIAL TECHNOLOGY/
MANUFACTURING OPERATIONS
Phone
_________________________________________
What year will you graduate from high
school? ______________________________________
Where do you go to school?
________________________________________________
________________________________________________
Mother/Guardian’s Name
________________________________________________
Phone _________________________________________
Father/Guardian’s Name
________________________________________________
Phone _________________________________________
In addition to parents/guardians, please list
another emergency contact name and
number
__________________________________________
__________________________________________
T- Shirt Size (based on adult size).
Circle choice
S
M
L
XL
2X
3X