Susquehanna Twp High School Susquehanna Twp High School Step 1 of 6 16% Welcome!Welcome to the TRUE COLORS Program! This form enrolls your student for the school year. It combines the Program Contract, the Photo & Video Release, and the Field Trip Permission & Medical Authorization. A parent or legal guardian must complete it. Your student will sign the Program Contract on Page 2. Please have your student's health insurance card and any medication or allergy information handy. The form takes about 10 minutes, and you can save and finish later. Student InformationStudent Name(Required) First Last Student Date of Birth(Required) Month Day Year Grade(Required)9th10th11th12thStudent Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Student Cell Phone(Required)Student Email(Required) True Colors T-Shirt Size(Required)SMLXL2XL3XLParent/Guardian InformationParent/Guardian Name(Required) First Last Relationship to Student(Required)MotherFatherLegal GuardianOtherParent/Guardian Phone(Required)Parent/Guardian Email Enter Email Confirm Email Parent/Guardian Email Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Photo & Video ReleaseThis pilot program is designed to give high school students the tools to transition into a chosen career after high school or college. The skills discussed in this program are important to ensure that each and every student who graduates from Steelton-Highspire School District has a fundamental understanding of how to succeed and thrive in college, at work, or both. Students will engage in discussions, case studies, portfolio development, presentation and speaking activities, business writing, email and telephone skills, as well as webinars and field trips. They will also interact with guest speakers. This agreement establishes an objective guideline for performance and behavior so all parties can operate in a positive atmosphere. It clarifies the expectations and procedures of the TRUE COLORS program. Students: read each section below and check the box to confirm.Section 1: Personal Attributes• Stay positive: be willing to seek and accept challenges and responsibilities. • Demonstrate an ability to adopt new ideas. • Respond positively and proactively to guidance and constructive criticism. • Maintain a high standard of dress, professional appearance, and hygiene. Wear the TRUE COLORS T-shirt to all functions. The TRUE COLORS T-shirt and khaki pants are required for all TRUE COLORS off-campus events.Section 1: Personal Attributes(Required) I have read and agree to Section 1, Personal Attributes.Section 2: Managing Relationships (Team Players)• Work well and establish good rapport with the multidisciplinary teams (cohorts). • Develop positive rapport with True Colors staff and educators. • Take advantage of the field trips and foster relationships that will enhance personal growth.Section 2: Managing Relationships (Team Players)(Required) I have read and agree to Section 2, Managing Relationships.Section 3: Oral Communication (One-on-One)• Communicate with True Colors staff, educators, and Steel-High teachers and staff. • Communicate with True Colors staff and educators about attendance or life situations that will prevent you from getting the most out of the program, by phone, text, email, or through Steel-High educators.Section 3: Oral Communication (One-on-One)(Required) I have read and agree to Section 3, Oral Communication.Section 4: Group Communication• In student group communication, EVERYONE should foster contributions from ALL members. • Provide positive feedback and constructive interaction to enhance group learning. • Mutual respect and professional conduct are MANDATORY.Section 4: Group Communication(Required) I have read and agree to Section 4, Group Communication.Section 5: Written Communication• Demonstrate a high level of PRIDE when submitting paperwork or assignments (written or virtual). • Assignments must be complete and submitted on time.Section 5: Written Communication(Required) I have read and agree to Section 5, Written Communication.Section 6: Field Trips• Display positive behavior and attitude during planned events. • Be on time for departure and return at the designated location. • Wear the TRUE COLORS attire (listed in Section 1) for Wednesday meetings and off-campus events.Section 6: Field Trips(Required) I have read and agree to Section 6, Field Trips.Student Signature(Required)Your NameYour NameYour NameYour NameStudent Signature Date(Required) Month Day Year Photo & Video ReleaseAs the parent or legal guardian of the student named on this form, I give the TRUE COLORS Program and Me Enhanced By We, LLC consent to use images or video footage of my student from this program for marketing purposes. I understand that neither my student nor I will receive any monetary compensation for the use of these images.This agreement establishes an objective guideline for performance and behavior so all parties can operate in a positive atmosphere. It clarifies the expectations and procedures of the TRUE COLORS program. Students: read each section below and check the box to confirm.Do you give consent for photos and video of your student?(Required) "Yes, I give consent" Field Trip & Transportation PermissionField Trip & Event PermissionI give permission for my child to attend TRUE COLORS Program field trips, off-campus events, and program activities during the school year. TRUE COLORS staff will share the date, location, and details of each trip before it takes place.Field Trip & Event Permission(Required) I give permission for my student to attend TRUE COLORS field trips and events.TransportationI give permission for my child to ride in any vehicle designated by the TRUE COLORS Program, its employees, and adult volunteers while participating in and traveling to and from program events.Transportation Consent(Required) I give permission for my student to ride in program-designated vehicles.Emergency Medical AuthorizationI understand that personal injury can and may occur to my child. I authorize the TRUE COLORS Program, or another appointed youth advisor, to seek and consent to emergency medical attention for my child as needed. I further agree to be liable for and to pay all costs incurred in connection with such medical attention.Emergency Medical Authorization(Required) I authorize emergency medical care for my student.Medical & Insurance InformationPlease provide all insurance, restriction, allergy, and medication information necessary for your student to receive appropriate medical care.Does your student have health insurance?(Required) Yes No Insurance Provider(Required)Member / Policy ID(Required)Group Number(Required)Policyholder Name(Required)Does your student have any allergies (food, medication, insect, or other)?(Required) Yes No List each allergy and the reaction(Required)Does your student take any medications?(Required) Yes No List each medication, dose, and time taken. Note any your student carries (inhaler, EpiPen, etc.)(Required)Does your student have any medical conditions, physical restrictions, or dietary needs?(Required) Yes No Please describe(Required)Emergency Contact InformationEmergency Contact Name(Required) First Last Relationship to Student(Required)Emergency Contact Phone(Required) Agreement & SignatureRelease of LiabilityMy child is voluntarily participating in the TRUE COLORS Program. I hereby release Me Enhanced By We, LLC, the TRUE COLORS Program, and their associates, directors, assigns, educators, employees, agents, personnel, and volunteers from any and all liability, claims, demands, causes of action, and possible causes of action whatsoever arising out of or related to any loss, damage, or injury (including death) that may be sustained by my child while participating in the program, including field trips and travel to and from program events.Release of Liability(Required) I agree to the Release of Liability.Responsibility for Property DamageI agree to accept full responsibility, financially or otherwise, for any damage my child may do to the property of the TRUE COLORS Program, properties visited on outings, others' personal property, or vehicles used for transportation.Program Contract (Parent/Guardian)(Required) I have reviewed the Program Contract with my student.Program Contract (Parent/Guardian)I have reviewed the TRUE COLORS Program Contract on Page 2 with my student and support the expectations it describes.Final Agreement & Electronic SignatureI am the parent or legal guardian of the student named on this form. The information I have provided, including medical and insurance information, is complete and accurate. I have read this entire form, and I agree and consent to all of the above stated. I understand that my electronic signature below has the same effect as my handwritten signature.I am the parent or legal guardian of the student named on this form. The information I have provided, including medical and insurance information, is complete and accurate. I have read this entire form, and I agree and consent to all of the above stated. I understand that my electronic signature below has the same effect as my handwritten signature.Final Agreement & Electronic Signature(Required) I agree and consent to all of the above.Parent/Guardian Signature(Required)Your NameYour NameYour NameYour NameParent/Guardian Signature Date Month Day Year CAPTCHA
