Information for Parents Summer Learning Place 2014

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Information for Parents Summer Learning Place 2014
Information for Parents
                                        Summer Learning Place 2014
                                        Furman University

WHAT IT IS:
  • A four-week (15 days, Monday through Thursday) comprehensive, small group instructional
    program for children/youth ages 6-14 with learning difficulties
  • Curriculum includes academics, social skills, and physical activities
  • Taught by graduate level teachers certifying in special education
  • Note: Enrollment is limited to a 4-to-1 student-teacher ratio
WHEN IT IS:
  • July 8-31, 8:30 a.m.- 11:30 a.m. (Monday through Thursday)
    Please note: The first day of the program will be Tuesday, July 8.
  • Students may arrive at 8:15 a.m. or later. There is no supervision prior to that time. Students
    must be picked up by 11:30 a.m.
WHERE IT IS:
  • Location: Sevier Middle School, 1000 Piedmont Park Road, Greenville, SC 29609
COST:
  • The charge to each student who attends is $150.00 (payable to Furman University; $50 due
    with application form and the remainder due by June 29)
WHAT YOU CAN EXPECT:
  • Evaluation of your child's specific learning abilities in academics, learning styles, and
    personal/social behaviors at the beginning of the program
  • Assessment of progress made during the program and a final report which may be shared with
    your child's school
  • Creative teaching and learning opportunities for your child
  • Ongoing communication with your child's Summer Learning Place teacher

FOR MORE INFORMATION:
      Contact Director Pat Hensley at 864-979-2232, patricia.hensley@furman.edu
WHAT YOU NEED TO DO:
     Spaces are limited and fill quickly! We encourage you to apply as soon as possible.
     Please submit the completed information forms with a $50 deposit, and
     send to:

   Erikah Haavie, Summer Learning Place, Furman University Education Department,
3300 Poinsett Highway, Greenville, SC 29613 or via e-mail to erikah.haavie@furman.edu
Information for Parents Summer Learning Place 2014
Information for Teachers
                                         Summer Learning Place 2014
                                         Furman University

WHAT IT IS:
  • A four-week (15 days, Monday through Thursday) comprehensive, small group
    instructional program for children/youth ages 6-14 with learning difficulties
  • Curriculum includes academics, social skills, and physical activities
  • Taught by graduate level teachers certifying in special education
  • Note: Enrollment is limited to a 4-to-1 student-teacher ratio

WHEN IT IS:
  • July 8-31, 8:30 a.m.-11:30 a.m. (Monday through Thursday)
    (Please note: The first day of the program will be Tuesday, July 8)

WHERE IT IS:
  • Location: Sevier Middle School, 1000 Piedmont Park Road, Greenville, SC 29609

COST:
  • The charge to each student who attends is $150.00 (payable to Furman University; $50
    due with application form and the remainder due by June 29)

WHAT YOU CAN EXPECT:
  • Evaluation of your child's specific learning abilities in academics, learning styles, and
    personal/social behaviors at the beginning of the program
  • Creative teaching and learning opportunities for your child
  • Assessment of progress made during the program and a final report which may be
    shared with you

FOR MORE INFORMATION:
                                Please contact:
                               Pat Hensley, Director
                              Summer Learning Place
                     Education Department, Furman University
                              3300 Poinsett Highway
                             Greenville, SC 29613-1134
                           patricia.hensley@furman.edu
Information for Parents Summer Learning Place 2014
Information Form
                                    Summer Learning Place 2014
                                    Furman University

Name of Child:

Name of School:

Date of Birth:                                                          Disability, if any:

Grade Placement (2013-2014):                                            Name of Teacher:

If applicable:     Resource              Self-contained                 Other Services:

Name of Parent/Guardian:

Home Address:

Telephone Number (work):                                                (home/cell):

E-mail Address:                                                         Gender (of child):     Male      Female
Who will bring child to SLP?_________________________               Who will pick up child?____________________________
Is your child eligible for free or reduced lunch?         Yes             No

                                                    Payment information:
                                  Visa                     Mastercard                         Check
Amount:           $50 deposit               $150 (paid in full)            $100 balance due           Other amount ___________
Card number: ________________________________________________________________________________
Three-digit security code (on back of card): _____________________ Exp. Date: _______________________________
Billing zip code: _______________________________________

                         Please Submit Form to: Erikah Haavie, Summer Learning Place,
                       Education Department, Furman University, Greenville, SC 29613-1134
                                erikah.haavie@furman.edu or FAX: 864-294-3341
2

                        Teacher Information Sheet: Assessment Results

Student name: _______________________________________________________________________________

                        Intelligence                                          Other Psychological Assessments

 Name of Test:                                                Name of Test:

 Date Administered:                                           Date Administered:

 Verbal IQ:                                                   Results:
 Performance IQ:
 Full Scale IQ:

 Achievement Assessments:

 Special Strength(s):

 Areas of Need:

 Teacher's Observations and Recommendations (use back of sheet for additional information):

 Related Services Received:

                                                                                       (Please use additional sheets if needed)
Medical Information Form
                                                Summer Learning Place
                                                             Furman University

Child's Name: __________________________________________________________               Age: ___________________

Parent/Guardian Name(s): ___________________________________________________________________________

Daytime Phone: ______________________________ Cell phone #: _________________________________________

Emergency contact name/phone number: ______________________________________________________________
(if different from above)

Does your child have any dietary/food restrictions?    ______Yes            _______No

If yes, please describe: _______________________________________________________________________________

List any specific allergies: ____________________________________________________________________________

Is medication for allergy being given? ______Yes            _______No

If yes, indicate name of medication: ___________________________________________________________________

If yes, are there any side effects? Please describe: _______________________________________________________

Is your child on any medication for behavior control? (hyperactivity, attention deficit, depression, etc.)?
                                       ______Yes            _______No

If yes, please indicate name of medication: _____________________________________________________________

If yes, are there any side effects? Please describe: _______________________________________________________

Is your child on any medication for epilepsy or other convulsive disorder? _______ Yes         _________ No

If yes, please indicate name of medication: ____________________________________________________________

If yes, are there any side effects? Please describe: ______________________________________________________

Please explain any other medical difficulties of which we should be aware: ________________________________

___________________________________________________________________________________________________

Parent/Guardian Signature: __________________________________________________________________________

Date: _______________________________

                                             Please submit form to:
               Erikah Haavie, Summer Learning Place, Furman University Education Department,
                     3300 Poinsett Highway, Greenville, SC 29613-1134, fax (864) 294-3341,
                                    or e-mail to erikah.haavie@furman.edu
rev: 3/14

                       Furman University Acknowledgement and Release Form

 My child’s school has my permission to send information concerning my child's educational progress
 to Furman University.

 School name: __________________________________________________________________

 Parent Signature: ______________________________________________________________

I, the undersigned, acknowledge that my son/daughter is voluntarily participating in Summer Learning Place, which is
being offered by Furman University. This program will begin July 8 and end July 31, 2014.

ASSUMPTION OF RISK AND RELEASE OF CLAIMS. In consideration of being permitted to participate in the Activity,
I acknowledge that I am aware of the possible risks, dangers, and hazards associated with my participation in the
Activity, including the possible risk of severe or fatal injury to myself or others. In return for the University allowing me
to voluntarily participate in the Activity, I agree to assume and accept all risks arising out of, associated with, or related
to my participating in the Activity and to be solely responsible for any injury, loss, or damage which I might sustain
while participating in the Activity. These risks include, but are not limited to, travel to and from location(s) visited
during the Activity.

To the maximum extent permitted by the law, I release and indemnify Furman University and its officers, directors,
employees, volunteers, and representatives, from and against any present or future claim, loss, or liability for injury to
person or property which I may suffer, or for which I may be liable to any other person, during my participation in the
Activity. I also grant Furman, in its sole discretion, full permission to take and use photographs of me, either alone or
with others, in any way deemed desirable by Furman. I do understand that my child’s last name will not be used in
conjunction with any video or digital images.

I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AGREE TO BE
BOUND BY ITS TERMS.

Child’s Name                                              Today’s Date

Parent Signature

                                              Please mail to:
            Erikah Haavie, Summer Learning Place, Furman University Education Department,
                 3300 Poinsett Highway, Greenville, SC 29613-1134, fax to (864) 294-3341
                                 or e-mail to erikah.haavie@furman.edu
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