ARCTIC Student Participation Packet

Student Participation Packet
One packet covers the entire school year. Complete this once and it applies to every ARCTIC Intensive your student attends during the school year written below. Tell us in writing if anything changes.
SCHOOL YEAR:
Return the completed packet to your CTE Career Guide or to the ARCTIC Director before travel. No student may travel without it. Attach a copy of the insurance card if you have one.
1 Student information
STUDENT NAME (last, first, middle)

First NameLast Name
DATE OF BIRTH

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
AGE
SCHOOL / DISTRICT
GRADE
HOME COMMUNITY
STUDENT CELL PHONE
Format: (000) 000-0000.
STUDENT EMAIL
example@example.com
2 Parent / guardian and emergency contacts
PARENT / GUARDIAN NAME

First NameLast Name
RELATIONSHIP
CELL PHONE
Format: (000) 000-0000.
HOME ADDRESS

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
EMAIL
example@example.com
SECOND EMERGENCY CONTACT

First NameLast Name
RELATIONSHIP
CELL PHONE
Format: (000) 000-0000.
3 Insurance and health care provider
INSURANCE CARRIER
POLICY / MEMBER NUMBER
GROUP NUMBER
PRIMARY CARE PROVIDER / CLINIC
PROVIDER PHONE
Format: (000) 000-0000.
PREFERRED FACILITY
TRIBAL HEALTH AFFILIATION (TCC, IHS, etc.)
MEDICAID / DENALI KIDCARE NUMBER
4 Medical information
List everything that applies. Write "None" where nothing applies — a blank line is treated as incomplete and may delay travel.
ALLERGIES — FOOD
ALLERGIES — MEDICATION
ALLERGIES — ENVIRONMENTAL
CHRONIC CONDITIONS (asthma, diabetes, seizures, etc.)
DATE OF LAST TETANUS SHOT

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
DIETARY RESTRICTIONS
PHYSICAL LIMITATIONS OR RECENT INJURY / SURGERY

Current medications - send every medication in its original labelled container.

Rows	MEDICATION	DOSE	WHEN TAKEN	REASON
1
2
3
4
5

Medication policy — please read.
- All prescription and over-the-counter medication is handed to ARCTIC staff on arrival. Staff store, dispense, and document every dose.
- Students may not keep medication in their possession — including vitamins, sleep aids, NyQuil, Benadryl, Tylenol, Advil, Aleve, Sudafed, and Mucinex.
- The only items a student may carry are listed below, and must still be written in above.
My student may carry:
Anaphylaxis: if this student has a history of severe allergic reaction, an EpiPen must travel with them.
5 Behavior and safety expectations
ARCTIC training sites are professional workplaces, not school environments. As a participant I agree to the following during all ARCTIC activities, travel, classes, and partnered training.
Professional conduct
- I will follow all directions from instructors, staff, and chaperones respectfully.
- I will use professional language and avoid joking, side conversations, or disruptive behavior during presentations and demonstrations.
- I will represent my school, my community, and ARCTIC in a mature and responsible manner at all times.
Facilities and equipment
- I will not touch tools, equipment, or materials unless instructed to.
- I will stay in designated areas and follow all site procedures.
- I will leave every facility cleaner than I found it.
Safety
- I will wear all required safety gear when instructed.
- I will walk, not run, and stay alert in shop and training areas.
- I will not engage in horseplay, distractions, or cell phone use in work zones or classes.
- I understand that inappropriate relationships, harassment, and any form of violent behavior are not permitted.
Engagement
- I will maintain a positive attitude and participate fully in all scheduled activities.
- I will ask thoughtful questions and engage respectfully with the professionals instructing me.
- I will remain with the ARCTIC group and my assigned chaperone at all times.
6 Tobacco, alcohol, and drugs — zero tolerance
This policy applies at all times and in all ARCTIC spaces — buildings, classrooms, vehicles, transportation, housing, off-campus sites, and partnered program locations.
- Tobacco products, including cigarettes, cigars, e-cigarettes, and chewing tobacco, are not allowed.
- Students may not possess or use alcohol under any circumstances.
- Possession or use of illegal drugs or drug paraphernalia is prohibited.
- Students may not possess or use any vaping devices or materials.
A student who violates this policy will be sent home immediately, will not be eligible to return for the remainder of the school year, and will have the violation reported to their site principal and superintendent. The home district will follow its own disciplinary protocol.

The Alaska School Activities Association classifies possession or use of tobacco, alcohol, drugs, or vape products as a TAD violation, which may carry penalties for school activities such as basketball, volleyball, or wrestling depending on district policy.

7 Photo and media release — your choice
This section is optional and is the one part of this packet you may decline. Saying no here does not affect your student’s participation in any way.
If you give permission, ARCTIC and its partner districts may photograph, film, and audio-record your student and use those images, video, audio, and your student's first name and school in the ARCTIC website and newsletters, social media posts, printed flyers and displays, presentations to schools, tribal organizations and industry partners, grant applications and reports to funders, and local news coverage about the program.
ARCTIC will never publish your student's full name alongside their photo without asking you first, and will never sell these images or use them in paid advertising.
Parent / guardian:
Student:
Optional limits — tick any that apply:

Other
8 Signatures
Two signatures complete this packet. Please read what each one covers.
Parent / guardian — by signing below I am agreeing to all of the following:
- I consent to ARCTIC staff, chaperones, and district personnel obtaining emergency medical, dental, surgical, and hospital care for my student during travel to, participation in, and travel home from ARCTIC Intensives. Staff will make every reasonable effort to reach me first; treatment may proceed without my prior consent if I cannot be reached and a licensed medical professional determines care is needed.
- I authorize release of the medical information on this form to treating providers, and authorize those providers to share information about care given with ARCTIC staff and with me. I understand I remain financially responsible for the cost of care.
- I authorize ARCTIC staff to store and dispense the medications listed in Section 4 and to document each dose.
- I have read the behavior expectations in Section 5 and the tobacco, alcohol, and drugs policy in Section 6 with my student.
- The photo and media choice I marked in Section 7 is my decision.
- The information on this form is accurate and complete, and I will notify ARCTIC staff in writing of any change before my student travels.
PARENT / GUARDIAN SIGNATURE
PRINTED NAME (Parent / Guardian)

First NameLast Name
DATE (Parent / Guardian)

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Student — by signing below I am agreeing to all of the following:
- I have read and understand the behavior and safety expectations in Section 5, and I agree to follow them.
- I have read and understand the tobacco, alcohol, and drugs policy in Section 6, and I understand that a violation sends me home immediately and ends my participation for the school year.
- I will hand all medication to ARCTIC staff on arrival, apart from anything my parent authorized me to carry in Section 4.
- The photo and media choice I marked in Section 7 is my own.
STUDENT SIGNATURE
PRINTED NAME (Student)

First NameLast Name
DATE (Student)

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Questions? Jerry Jones, ARCTIC Director • jjones@dgsd.us • (907) 841-0703 • Jenny York, CTE Career Guide, Alaska Gateway School District • jyork@agsd.us • (907) 209-4990
Return this packet to your CTE Career Guide or the ARCTIC Director before travel - arcticstudents.org
Should be Empty:

Student Participation Packet

1 Student information

2 Parent / guardian and emergency contacts

3 Insurance and health care provider

4 Medical information

Medication policy — please read.

5 Behavior and safety expectations

6 Tobacco, alcohol, and drugs — zero tolerance

7 Photo and media release — your choice

8 Signatures

Parent / guardian — by signing below I am agreeing to all of the following:

Student — by signing below I am agreeing to all of the following: