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Dear Parents/Guardians:
This letter is to inform you about an extra credit assignment for AP Biology to attend a Science related
conferences over February break. The conference is excellent academic opportunities for your student especially if they
are interested in a STEM (Science, Technology, Engineering and Math) career. On February 24th a conference centered
around environmental advocacy work called the YES Conference. This conference will include panel discussion,
collaboration opportunities and other activities related to environmental advocacy. This conference is free to students, as
long as they preregister.
While I encourage students to attend the conference, neither myself nor other staff at KIPP King Collegiate will
be able to provide transportation for students to and from the event as they and will not be in attendance as it is a
conference specifically for students. Because of this I ask that if your student is interested in attending, they arrange their
own method of transportation. I understand that this is short notice and appreciate your flexibility and support if your
student decides this is an opportunity they want to pursue. I have included the website as well as details of the date, time
and location.
I ask that if you and your student have discussed this conference and made the decision that they are going to
attend for you to please fill out the form attached to this paper and sign it for your student to return by Thursday,
February 15th. If you have any questions about this please do not hesitate to reach out to me by email:
amy.krause@kippking.org or by phone at 5105061663
Conference Details:
YES Conference:
Website: http://www.sparetheairyouth.org/2018yesconference
Date: Saturday, February 24th from 9 am to 3 pm
Location: Laney College, 900 Fallon Street Oakland, CA
Transportation Options:
.
Best,
Amy Krause
AP Biology and Physics Teacher
KIPP King Collegiate High School
PARENT/LEGAL GUARDIAN SECTION : MUST BE COMPLETED
Parent/Legal Guardian Phone Contact During Time of Trip :
Name: _____________________________________
Work Phone:_________________ Cell Phone: _________________________Home ____________________
Name: _____________________________________
Work Phone:_________________ Cell Phone: __________________________ Home ____________________
Other Emergency Contact:
Name: _____________________________________
Work Phone:_________________ Cell Phone: Home:____________________
(“ Other” emergency contact is not used to authorize medical treatment )
Conference my student is attending:
________ YES Conference
In order to get to the conference (check one):
_______I will take them _______They may get a ride with ________________________ (name)
_______They may take BART _______Other transportation: ___________________________________
When my student leaves the conference (check one):
_______I will pick them up _______They may get a ride with ________________________ (name)
_______They may take BART _______Other transportation: ___________________________________
Physician and Insurance Information :
Name:______________________________________________
Medical Insurance Type and Number: _____________________________________
Phone: _____________________________________
Student Medical Needs for Trip (Allergies/Medical Conditions/Physical Limitations/Medications): ____________________________
________________________________________________________________________________________________________
IF PARTICIPANT IS A MINOR:
I acknowledge that I have carefully read this document, waiver, and release, and understand the information therein. My signature on
this form shall constitute an informed and knowing waiver as required by law. I agree to each of the terms and acknowledgments
above, and agree to permit my child to participate in the trip described above.
Date: _____________________________________
Signature of Participant (Student under age 18) _____________________________________
Date: _____________________________________
Signature of Parent/Legal Guardian (in individual capacity and on behalf of Participant) _____________________________________
Parent/Legal Guardian Name (Please Print) _____________________________________
IF PARTICIPANT IS AN ADULT OVER 18:
I acknowledge that I have carefully read this document, waiver, and release, and understand the information therein. My signature on
this form shall constitute an informed and knowing waiver as required by law. I agree to each of the terms and acknowledgments
above, and sign this document on behalf of myself, so that I may participate in the trip described above.
_______________________________________________Date:_________________
Signature of Participant (Student over age 18)