Whitman Hanson Summer Enrichment 2026 Application

Whitman Hanson Summer Enrichment 2026 Application
Name

First NameLast Name
Grade as of August 2026
Home Address
Student Preferred Language
Student Birthday
Please specify if your child has any allergies
Will student require transportation to attend?
Parent/Guardian Name
Parent/Guardian Preferred Language
Parent/Guardian Preferred Phone Number
Format: (000) 000-0000.
Parent/Guardian Email
example@example.com
Questions? Call 781-618-7508 or 21stcenturyenrichment@whrsd.org

Attendance, Credit, and Cellphone Policy

Attendance will be taken daily. Students enrolled in the program are expected to attend each day, including Field Trip days. If a student is going to be absent please call and leave a message at 781-618-7508 or email 21stcenturyenrichment@whrsd.org.

HIGH STUDENTS ONLY: Elective Credits are issued for

attendance and active participation in this program. Reminder that these are bonus credits, that only help students as they move through High School. Students who attend the entire program will receive 4 elective credits. As the program is only 16 days, repeated absences will result in students receiving less credits. For example, if a student only attends a total of 11 of the 16 days, they will receive 3 credits. This is not a punishment for students but a reflection of their participation.

Cellphones and Earphones are to remain in a students bag during class time. Repeated reminders will result in a phone being sent to the office for the remainder of the day

I understand the policies above and my student will abide by them.
ParentGuardian Signature
Date

MonthDayYear
Date

Photo & Media Release

During the Summer Enrichment Program, photographs and/or videos may be taken of students participating in activities, events, and projects. These images help us celebrate student learning and share highlights of our program with families and the community.

I grant permission for my child to be photographed and/or recorded during the Summer Enrichment Program.

I understand that these images and/or videos may be used for:
- Program newsletters
- School or district website
- School or district social media pages
Please select one:
Signature
Date

MonthDayYear
Date

Whitman Hanson Regional School District Extra-Curricular Emergency Medical Information Form

***Note: The school nurse may not be present during before or after school programs***
Student Name
Address
Home Phone
Format: (000) 000-0000.
Parent/Guardian Cell Phone
Format: (000) 000-0000.
Parent/Guardian Cell Phone
Format: (000) 000-0000.
My child has the following medical condition that may require immediate attention (911) at after school activities:

Other
Allergy to
Requires Epinephrine?
Asthma
Requires Inhaler?
Diabetes
Seizures
Other

BASIC ACTION PLAN TO FOLLOW - UNLESS PARENT PROVIDED INDIVIDUAL ACTION PLAN:

Allergic Reaction: Symptoms include - Difficulty breathing, shortness of breath, wheezing, difficulty swallowing, hives, itching, swelling of any body part, and vomiting. ACTION - CALL 911 AND ASSIST THE STUDENT IN USING AN EPINEPHRINE AUTOINJECTOR IF PRESCRIBED AND AVAILABLE

Asthma: Symptoms include - Difficulty breathing, wheezing, and shortness of breath. ACTION - IF THE STUDENT HAS THEIR INHALER, ALLOW THEM TO USE IT. IF NO RELIEF OF SYMPTOMS IN 5 MINUTES CALL 911. IF NO INHALER IS AVAILABLE, CALL 911

Diabetes: Symptoms of Low Blood Sugar include - Hunger, sweaty, pale, feels shaky, and headache ACTION - ALLOW STUDENT TO DRINK JUICE, EAT GLUCOSE TABS OR FAST ACTING CARBOHYDRATE FROM THEIR EMERGENCY PACK. HAVE STUDENT TEST THEIR BLOOD GLUCOSE LEVEL AND RECORD THE NUMBER. IF NO CHANGE IN SYMPTOMS IN FIVE MINUTES CALL 911 AND HAVE THE STUDENT REPEAT ALL OF THE ABOVE.

Seizure: Altered consciousness, involuntary muscle stiffness or movements, drooling/foaming from the mouth, temporary halt in breathing, loss of bladder control. ACTION - GUIDE STUDENT TO THE FLOOR TO PROTECT FROM FALLING, AND CALL 911. NEVER PUT ANYTHING INTO THE STUDENT'S MOUTH.
Parent/Guardian child-specific instruction for any of the above action plans - include the location of emergency medication:
Parent Signature
Date

MonthDayYear
Date

WHITMAN-HANSON REGIONAL SCHOOL DISTRICT SCHOOL SPONSORED TRIPS PARENT/GUARDIAN PERMISSION
I give permission for my son/daughter to participate in Summer Enrichment Field Trips.
Student Name
I understand and agree that while on this trip my son/daughter is required to comply with all policies and regulations of the School District, particularly those pertaining to proper conduct and substance abuse.

I understand and agree that while on this trip, my son/daughter is required to comply with all policies and regulations of the School District, particularly those pertaining to proper conduct and substance abuse.

Furthermore, I understand and agree that, if necessary as determined by the Enrichment Staff, my son/daughter shall be sent home. This action cannot be appealed and will be taken after I have been notified by the Enrichment Staff of the reason(s) for this action.

During the time of this trip, I may be reached as the following address and telephone number:
Address
Telephone
Format: (000) 000-0000.
My child takes the following medication(s):
Student Name
Medication:
Time Taken:
Medication:
Time Taken:
If my child has a medical concern or takes medication, a nurse would ONLY be asked to attend the field trip if deemed warranted by the building school nurse and principal. In the event a nurse is not attending this fieldtrip, every effort will be made to have trained personnel present.

I agree to all of the terms above and allow my son/daughter to receive emergency medical treatment if necessary.
PARENT SIGNATURE
Date

MonthDayYear
Date
Should be Empty: