Co-op Forms and Requirements This is how things are done at L.W.H.S.

MONDAY MEETING

Monday Meeting is Mandatory!!!!!! If you do not come to Monday Meeting and you are at school you will be turned in as skipping my class!!! Monday meeting is the only time that I will be able to tell you important information! You MUST attend! Skipping my class is just like skipping any other class!! BE THERE!!!

Pay Stubs and Paychecks

Pay Stubs Pay stubs will be collected every month!! SAVE THEM!!! If you don’t get paid with a paycheck and a paystub attached, you probably do not have a job that Marion County will accept as a real job!! SEE ME!!!! You MUST have Federal Taxes and Social Security taken out of you Paycheck before it is a real job!

Paychecks You must be paid with a Paycheck! If you don’t, SEE ME!!!! You must have taxes and Social Security taken out! YES, I’ve said that twice!! If you don’t have a REAL job, you must get another job or drop the class!! YES, I SAID DROP THE CLASS!!!!!

Co-op Fact Sheet This form tells the Coordinator some of the basic facts about the student. It must be filled in correctly and legibly with INK !!! No forms will be accepted in pencil or written illegibly.

Transportation Form

This form is an agreement between Marion County Schools and your parents or guardian. It gives you permission to drive from campus to your O.J.T. location It also states that you agree to not ride with, or transport OTHER work program students.

OVERNIGHT  OUT-OF-STATE ” OFF-CAMPUS SCHOOL ACTIVITY OFF CAMPUS  PARENT CONSENT / LIABILITY WAIVER / MEDICAL RELEASE Student: _________________________________________Student ID#: ___________________ School: _ LAKE WEIR HIGH_______ Club/Group/Class: __ C.D.E. CO-OP CLASS ____________Supervising Faculty Member: _ MR. TERRY BRUNSON __________________ Activity: __ O.J.T. / VOCATIONAL TRAINING ___________Location: ________________________________________________________ _____________________________________________________________________________________________________________________ Date & Time of Departure: DAILY AT O.J.T RELEASE TIME Date & Time of Return: WILL NOT RETURN WITHOUT PERMISSION _______ Method of transportation: q  Private Car SWIMMING WILL NOT BE PERMITTED. MEDICAL INFORMATION Date of Birth: ______________Ht: _______ Wt: _______ Date of your child’s last tetanus shot: ____________ Does your child have any of the following conditions? Epilepsy / Seizures  Yes  No Motion Sickness  Yes  NoDiabetes  Yes  qNo Hemophilia / Bleeding Disorders  Yes  NoAny Medication  Yes  NoAsthma / Wheezing  qYes  qNo Heart Disease  Yes  No Muscular / Skeletal Problems  Yes  NoAny other condition which might possibly require treatment during the trip? q  Yes  No If yes, please specify: ___________________________________________________________________________________________________________________ Is your child currently being treated for any illness?q  Yesq  No If yes, please specify: _______________________________________________________ List any allergies to: Medicines ___________________Insects ____________________Foods _____________________Other ________________________ Are there any foods your child cannot eat?  qYes  qNoIf yes, please specify what foods? _________________________________________________ PARENT CONSENT / LIABILITY WAIVER / MEDICAL RELEASE !I/We hereby give permission for my child to accompany employees of the Marion County School Board, acting as chaperones, to __________________________ for the days indicated above. I/We will not hold the Marion County School Board nor their agents or employees accompanying the group responsible for any accident or injury to my child except as caused by the negligence of the School Board, its employees and agents.” !In the event my child causes any property damage or personal injury, whether individually or in concert with other persons or entities, I/We agree to indemnify and hold harmless the Marion County School Board, its agents and employees.” !I/We have read all the information in regards to this trip. I am aware of guidelines of said trip and the number of chaperones which will accompany my child.” !“I/We hereby grant permission to the attending physician or his consulting physicians, to render to my son/daughter any emergency treatment, medical or surgical care that might be deemed necessary to the health and well-being of said child. Also, when necessary for the administering of such care, I grant permission for hospitalization at an accredited hospital. !I/We assume full responsibility and liability for any and all expenses, damage, accident, illness, injury or medical expense of and to my/our child or our property resulting from such participation. I/We attest and affirm that the participant has no limitation that should prevent participation in the activity and I/we have not been advised or informed by anyone to the contrary. ! I/We further agree to inform the appropriate school official(s) should my/our child’s physical condition change in any way and any time so as to affect his/her participation in the activity herein named.” My Student has medical insurance: q  Yes q  NoInsurance Co: ______________________Policy # ____________________ _____________________________________________________ ____________________________________ Home Telephone# Work Telephone#Pager / Cell phone#Emergency Telephone# _________________________________________________________________________________________________________ Parent Signature / DateHome Address / City / Zip Equal Opportunity Schools / Drug Free Workplace Save-A-Friend / Friend RMD102 New Date 02/03

OVERNIGHT  OUT-OF-STATE ”OFF-CAMPUS SCHOOL ACTIVITY OFF CAMPUS  PARENT CONSENT / LIABILITY WAIVER / MEDICAL RELEASE Student: _________________________________________Student ID#: ___________________ School: _ LAKE WEIR HIGH_______ Club/Group/Class: __ C.D.E. CO-OP CLASS ____________Supervising Faculty Member: _ MR. TERRY BRUNSON __________________ Activity: __ O.J.T. / VOCATIONAL TRAINING ___________Location: ________________________________________________________ _____________________________________________________________________________________________________________________ Date & Time of Departure: DAILY AT O.J.T RELEASE TIME Date & Time of Return: WILL NOT RETURN WITHOUT PERMISSION _______ Method of transportation: q  Private Car SWIMMING WILL NOT BE PERMITTED. MEDICAL INFORMATION Date of Birth: ______________Ht: _______ Wt: _______ Date of your child’s last tetanus shot: ____________ Does your child have any of the following conditions? Epilepsy / Seizures  Yes  No Motion Sickness  Yes  NoDiabetes  Yes  qNo Hemophilia / Bleeding Disorders  Yes  NoAny Medication  Yes  NoAsthma / Wheezing  qYes  qNo Heart Disease  Yes  No Muscular / Skeletal Problems  Yes  NoAny other condition which might possibly require treatment during the trip? q  Yes  No If yes, please specify: ___________________________________________________________________________________________________________________ Is your child currently being treated for any illness?q  Yesq  No If yes, please specify: _______________________________________________________ List any allergies to: Medicines ___________________Insects ____________________Foods _____________________Other ________________________ Are there any foods your child cannot eat?  qYes  qNoIf yes, please specify what foods? _________________________________________________ PARENT CONSENT / LIABILITY WAIVER / MEDICAL RELEASE !I/We hereby give permission for my child to accompany employees of the Marion County School Board, acting as chaperones, to __________________________ for the days indicated above. I/We will not hold the Marion County School Board nor their agents or employees accompanying the group responsible for any accident or injury to my child except as caused by the negligence of the School Board, its employees and agents.” !In the event my child causes any property damage or personal injury, whether individually or in concert with other persons or entities, I/We agree to indemnify and hold harmless the Marion County School Board, its agents and employees.” !I/We have read all the information in regards to this trip. I am aware of guidelines of said trip and the number of chaperones which will accompany my child.” !“I/We hereby grant permission to the attending physician or his consulting physicians, to render to my son/daughter any emergency treatment, medical or surgical care that might be deemed necessary to the health and well-being of said child. Also, when necessary for the administering of such care, I grant permission for hospitalization at an accredited hospital. !I/We assume full responsibility and liability for any and all expenses, damage, accident, illness, injury or medical expense of and to my/our child or our property resulting from such participation. I/We attest and affirm that the participant has no limitation that should prevent participation in the activity and I/we have not been advised or informed by anyone to the contrary. ! I/We further agree to inform the appropriate school official(s) should my/our child’s physical condition change in any way and any time so as to affect his/her participation in the activity herein named.” My Student has medical insurance: q  Yes q  NoInsurance Co: ______________________Policy # ____________________ _____________________________________________________ ____________________________________ Home Telephone# Work Telephone#Pager / Cell phone# Emergency Telephone# _____________________________________ ____________________________________________________________________ Parent Signature / DateHome Address / City / Zip Equal Opportunity Schools / Drug Free Workplace Save-A-Friend / Friend RMD102 New Date 02/03

Parent-Student Agreement This form list the rules and expectations that the L.W.H.S. Cooperative Education Student must achieve to be a success in the program and on the job.

Employers Agreement This agreement is between The Marion County School Board and your employer. Among other things, it spells out that the coordinator( that’s Mr. Brunson) has the authority to keep you in school, to change your work schedule and even to deny you the right to work at a certain job. If this happens, you have agreed to abide by my judgments, or drop the class.

Student Training Plan These are things that your employer will want you to learn on the job (O.J.T.) These things are found on your BLUE CARD

Blue Card