russia local school district - coffeecup...
TRANSCRIPT
Russia Local School District Where Children Come First 2014-2015 Back to School Newsletter Steven J. Rose, Superintendent Karen B. Bensman, Principal
A Message from the Superintendent…
During last few years, our students and staff have experienced a tremendous amount of change within
the district. Last year, in grades 7-12, we transitioned to an eight period day and a modified block schedule.
This was a huge change but overall it was well received by both the students and staff once they became
accustomed to it. Students seemed to enjoy having a few extra minutes of class time in which teachers could
provide more direct instruction or give students assistance with their homework. Many students have also
commented that the modified block schedule seemed to break up the week. The good news is that there are very
few changes with the schedule this year. The biggest change this year is with staffing. We had a large turnover
of staff members with several taking jobs in other districts that pay better. It is extremely hard for a small
school like Russia to compete with the pay at larger districts and still live within our budget. The positive news
is that we were able to fill all the positions with quality candidates that truly want to teach here and appreciate
the supportive community in which we live.
District Test Scores: Once again the hard work of the students, staff, and parents shine through on the
standardized testing. This year Russia’s Preliminary Performance Index (which I truly believe is the best
indicator of a school’s academic success) looks to be around 110 which is the highest in the school’s history. It
is possible that this score will place Russia in the top ten of public schools in the state which is an amazing
accomplishment. I want to convey my utmost gratitude to all the students, staff, and community members that
have helped our students reach this level of achievement. I also want to assure community members that
although we take great pride in our academic achievement, our number one priority is to provide students with a
nurturing environment in which every student feels safe and secure.
School District Finances
For the third year in a row, Russia Local School was able to finish the 2014 fiscal year with a positive
cash balance. This past year, the district was able to purchase a new bus which was the first “new” bus the
district has purchased since 2007. Once again, I would like to thank the community for its support in renewing
the levy in May at an effective rate of 7.56 mils. The passage of this levy allows the district to maintain our
current operations without any additional taxes on the community.
New Staff Members: The start of the 2014-2015 school year brings a variety of new faces to the
district and the loss of a few veterans that we will greatly miss. I will start with the High School staff. Mr.
Chad Topp will be teaching Junior High and High School Social Studies including AP European History. He
comes to Russia with five years of experience. What impressed us most about Mr. Topp is his love for the
content and his desire to be in a school like Russia.
You may have already seen him leading the band around town during band camp this summer but please
welcome Mr. Michael Fulk as our new instrumental music teacher/band director. Mr. Fulk comes to Russia
with ten years of experience directing the band program at Union Scioto in Southern Ohio and is excited to be
closer to family. An interesting fact about Mr. Fulk is that his wife is the current band director at Bradford.
The next staff member is definitely not new to Russia but will have a new position this year. Mrs. Ola
Schafer retired this past spring from her full time social studies position and is coming back to Russia in a part
time position. She will be mentoring students who are taking AP Government online. We are glad she will still
be in the building this year!
This year we also have a new person taking over the reins of our Guidance Department. Mrs. Tonya
Slonaker is our new K-12 Guidance Counselor. She comes to us from Sidney and has over six years of
experience as an elementary counselor. Although she truly enjoys working with the younger students, she is
equally excited to learn the high school portion of the position. An interesting fact about Mrs. Slonaker is that
she has a certified therapy dog named Gunnar that she uses to bring comfort to patients in nursing homes and
hospitals. I wouldn’t be surprised if the students would get a chance to meet Gunnar this year. To help assist in
this transition, Mr. Bremigan will return on a part time basis to help mentor Mrs. Slonaker and will also be
teaching P.E. for students in grades 7-12.
We will also have several new faces in the elementary to start the year. First, we have Janel Slonkosky
(many of you may remember her as Janel Meyer) who graduated from Russia in 2005. She will be teaching
Math to all students in grades 5th
and 6th
, and one section of 7th
grade math this year. Janel will also be coaching
7th
and 8th
grade volleyball as well, but may miss a few weeks as she welcomes a new addition to her young
family.
Our new teacher in first grade is Ms. Jill Hemmelgarn. Ms. Hemmelgarn is a graduate of Versailles
High School and was a second grade teacher at Sidney this past year. An interesting fact about Ms.
Hemmelgarn is that we had over 100 applicants for this position and Ms. Hemmelgarn went above and beyond
to separate herself from the others!
Finally, you will see one more familiar face in the elementary halls at the start of school this year. Ms.
Kathy Bevans will be doing a long term sub position at the start of the school year for Mrs. Katie Rethman who
will be on maternity leave.
Please join me in welcoming our new staff members. I truly believe that they will all be wonderful
additions to our school!
Sincerely,
Steven J. Rose
Superintendent
From the Principal…
It is difficult to believe that we are ready to get the 2014-15 school year under way. The elementary
students will come to school with no major changes to their daily schedule. To meet your teachers and see your
classroom and classmates before school begins, be sure to attend Back to School Night on Monday, August 18,
2014 from 6:00 to 8:00 PM. You can place your belongings in your classroom that night and have less to carry
to school on your first day which is Wednesday, August 20th
.
Regarding before and after school hours; please be aware that parents who drop off and pick up students
have the same arrangements as last year. The entrance located near the cemetery is where we would like the
drop off and pick-up to occur. We ask that you do not drop off and pick up from the front entrance by the school
office because of other traffic in the church parking lot. All student drivers must park in the south parking lot
behind the school and enter through the athletic entrance. Students walking or riding bicycles to school should
also enter through the athletic entrance. Please put your bicycles in the appropriate marked areas, which never
includes the parking areas marked for handicapped parking. Once students arrive at the school, K-6 students
must report to the athletic entrance until the 7:55 bell rings.
High school students will return with the same schedule as last year. Monday, Thursday and Friday will
be the regular eight period day schedule. Tuesday and Wednesday will be block days. This schedule will also be
the same as last year with Tuesday classes to be even periods. So you will be in the class periods that are
scheduled for periods two, four, six and eight. Wednesday will then have the odd periods so you will be in
classes that are scheduled for periods one, three, five and seven.
Advanced Placement (AP) and Dual Enrollment (DE) classes continue to be offered to allow high
school students to take advanced classes with the ability to earn college credit. These classes are taught by
Russia teachers who must follow criteria set forth by The College Board for AP classes and by Urbana College
for the DE classes. If you are still contemplating either of these options please see Mr. Bremigan or Mrs.
Slonaker before school starts.
Please be reminded that students may bring their personal technology devices such as iPads, Kindles,
Nooks and the like to use for educational purposes, provided they have completed and turned in the Technology
Device Policy form. This form can be picked up from the school office or printed from the school website.
There is one major change on this year’s policy; iPod touch devices will not be permitted. Cell phones may be
brought to school but may not to be used during the school day.
I am looking forward to my second year as principal of Russia School. If you have questions on any of
the above information, do not hesitate to contact me at school. Enjoy the last few weeks of summer!
Sincerely,
Karen B. Bensman
Principal
Severe Weather Information
We will use the One Call Now system to inform parents and students of weather related delays and closings.
Parents and students are advised to listen to the following radio and TV stations for school closings and delay
information during periods of fog and severe weather:
WMVR 1080 AM-105.5 FM-Sidney TV Channels: 2(WDTN) - 7(WHIO) - 22(WKEF/WRGT)
Ch. 8 on Cable
Early dismissals: Arrangements should be made with children, if both parents work, so they will know what to
do and where to go in case of an early dismissal.
Endowment Fund Established
Russia Local School has established an endowment fund through The Community Foundation of Sidney
and Shelby County. The purpose of this Fund shall be to provide financial support for programs, activities
and projects of Russia Local School. By establishing the fund through the Foundation, Russia School will
receive maximum interest on all donations. Also, the Foundation has public charity status from the IRS;
therefore any person donating will receive the maximum charitable deduction for income, gift, and estate
tax purposes. If you have any questions regarding donations, please contact Mr. Rose.
When Is Your Child Too Sick To Come To School
Listed below are some guidelines to consider when deciding to send your child to school or keep your child at
home. Your child is too sick to go to school if any of these symptoms are present:
• Has a temperature above 100 degrees Fahrenheit by mouth. When your child has been free
of fever for 24 hours, is feeling better, and does not have other symptoms he/she may return.
• Has a pain from an earache, headache, sore throat, or recent injury.
• Has a cough that interferes with your child’s daily routine.
• Has shortness of breath or an increase in wheezing.
• Has vomiting or diarrhea.
• Has yellow or green drainage from the eye(s).
• Has broken out in a rash.
• Has a contagious disease such as chicken pox, strep throat, or “pink eye”.
Consult your physician or the Shelby County Health Department if you have questions about what is contagious
or have any other concerns about sending your child to school. Please refer to the student handbook for more
details on student absences.
On-Line Grading
Parents have the ability to view their child’s grades on-line. Logins and Passwords for all Kindergarten
students will be assigned after the start of the school year. Students in grades 1-12 already have passwords
and those passwords remain the same. If you have misplaced your password, please stop by the school
office or call the school to get this information. You may share your ID and Password with your child, but
please be advised that they will then have access to change your password and/or look at your other
children’s grades if you link them together. If you have any questions, please contact the school at 526-
3156.
2014-15 BOOK FEES & CLASS SCHEDULE PICK UP
Russia students are requested to pick up class schedules and pay book fees in the school office on the following
dates: Monday, August 4 8:00-4:00
Tuesday, August 5 8:00-4:00
Wednesday, August 6 8:00-4:00
Thursday, August 7 8:00-4:00
Friday, August 8 8:00-4:00
See the “book fees payment form” on the school website under resources/ forms. Please bring this form
with you when paying these fees.
Book fees for all of your children can be paid with cash or by writing a check payable to Russia School.
Kindergarten....$30.00 Grades 1-4....$75.00 Grade 5-6……...$50.00 Grade 7-8......$40.00
Band Fee for Grade 6 should also be added to this check ($15)
Junior High Course Fees:
Family Consumer Science………$15
Industrial Tech…………………..$15
Instrumental Music……………...$15
Keyboarding (Gr. 8).…………….$20
High School Course Fees:
Art I……………. $23.00 Computer App I............ $20.00 Physics……..………. $20.00
Art II……………. 26.00 Graphic Design……….. 20.00 Senior Science……….. 8.00
Art III………….... 28.00 Multimedia Tech……… 20.00 AP Chemistry.............. 15.00
Art IV………........ 28.00 Personal Financial Mgt... 5.00 HS Inst. Music………..30.00
Ceramics I............. 25.00 Healthy & Safe Foods… 30.00 Spanish I……………..16.00
Ceramics II……… 25.00 Child Development……. 10.00 Spanish II…………… 16.00
Ceramics III…...... 25.00 Healthy Living……….... 35.00 Spanish III…………... 21.00
Ceramics IV…….. 25.00 Career Search I or II..…. 10.00 Industrial Tech I……... 5.00
Crafts……............. 23.00 Anatomy………………. 25.00 Industrial Tech II…….. 5.00
Accting I………... 55.00 Biology I……………..... 15.00 Industrial Tech IS……. 5.00
Accting II.............. 75.00 Chemistry………........... 15.00 Technology Fee………10.00
Keyboarding……. 20.00 Earth/Space Science…… 10.00
Apple Mac App…. 20.00 Life Science…………… 10.00
Computer Lit……. 20.00 Physical Science............. 5.00
School will open Wednesday morning, August 20th
. Students are asked to report to their first period
class before the 8:05 a.m. bell. Students are not to arrive at school before 7:55 AM.
Please refer to the school website (www.russiaschool.org)
for additional back to school forms:
lunch deposit form, lunch menu, emergency medical form,
book fees payment form, and school supply list.
LUNCH INFORMATION FOR 2014-15
Russia School will be using the “Meals Plus Automated Payment System” lunch program again this
school year. Prices for the 2014-15 school year are:
Grades 1-6: $1.95 Grades 7-12: $2.20 Adults: $2.50
Students will be given the choice of 1 of 2 main entrees or peanut butter/jelly sandwiches. This will continue
again this school year.
The Ohio Department of Education School Lunch Program regulations will not allow students to substitute
orange juice for milk unless written consent from a physician is on file in the school office. However, students
may purchase orange drink in addition to the milk without written consent. Students who may be allergic to
milk and want orange juice as a substitute are urged to bring written consent from their physician to school on or
before the first day of school.
Free or reduced lunches are available for families with financial hardship. Applications can be picked up in the
school office.
Telephone Use
A public telephone is provided for students to use in the hallway by the Clair C. Naveau gym. However,
students must use the office telephone to call home when they are sick or in the case of an emergency. Parents
are requested not to ask that a student be called from class or given a message unless it is an emergency.
Russia School has voice mail available for all staff 24 hours a day.
WASHINGTON DC TRIP
The Washington DC trip for 8th
graders is scheduled for October 14 – 19, 2014. The final payment is $198 for
all chaperones and students. All payments are due by Friday, September 5, 2014. A notice concerning the
rooming list will be attached to your child’s class schedule. Please complete and turn the rooming list in to the
school office by Friday, August 15.
Ohio Driver’s Education Law
You must be 15 years and 5 months old to take the driver’s education class in the state of Ohio. Classes are
offered through Ft. Loramie School, the Shelby County AAA or any other private driving school.
Assignment Books for 2014-2015 School Year
Assignment books for the 2014-2015 school year will be given to all students in grades 5-12 at no charge. No
cloth book covers (book sox) are available through the school. Reminder: adhesive book covers are not
permitted!
New Arrivals for the Class of 2032
Amelia Beatrice Wagnild May 21, 2014 Kevin & Ashley (Hart) Wagnild
Gavin Stanley Heuing Jun 2, 2014 Brandon & Crissa (Siler) Heuing
Anna Leah Phlipot Jun 12, 2014 Kevin & Julie (Garman) Phlipot
Medication Policy 2014-15
All medication (including non-prescription medicines such as Tylenol) must be kept in the office and
administered by office personnel only. Medications can only be administered to a student in accordance with
the following mandates:
All medication must be sent to school in the original container.
All medication must be accompanied with written permission from a parent/guardian. Information on
the note must include the student’s name, dosage, time(s) & date(s) that it is to be administered and
parent/guardian signature. This form is located on the Russia Local School website.
If medication needs to be administered for an extended period of time, parents need to have the
doctor complete the top portion of the “Physician’s Request for the Administration of Medication by
School Personnel” form and a parent completes the bottom portion. Please notify the school office if
you have any questions or if you need a form.
Medication can be sent in for a full week's dosage.
Cough drops can be kept in the classroom. Send a note to the teacher(s).
Thank you for cooperating in carrying out this state mandate.
EMERGENCY MEDICAL FORMS NEED COMPLETED
You will need to complete a new Emergency Medical form this year. These forms were revised this summer.
Please use this updated form. Once signed and completed, please drop these off in the school office.
Available on our website under “resources” are forms in 2 different formats (“tab form” and “not tab” form). In
order to use the “tab form,” you will need to have Microsoft Office 2007. To use the “not tab” form, you need
Microsoft Office ’97. Families with Microsoft Office 2007 are asked to use the “tab form.”
If you used the “tab form” last year and you saved your form on your computer, just update your form by
correcting the grade level, the Teacher Name (grades K-6 only), HS student ONLY cell#, and any other info that
might have changed from last year (cell phone numbers, address, etc.). Please make sure information is listed in
each “tab” section.
Families with students 9-12, please note: if you were completing the “tab form” in the past and your form does
not include the “HS student ONLY cell#” listed at the top next to the teacher name, please download the latest
“tab form” and complete.
If you used the “not tab form”, just print off this form, complete it in full and drop it off in the office.
EVERYONE: please complete all sections of this form. Put “NA” if you don’t have any information for a
section. Do not use “NA in the “Name of Relative OR Childcare Provider” and “Who should the school contact
first?” The school needs information from you on these two sections.
ELEMENTARY SUPPLIES
KINDERGARTEN
1 back pack 1 paint shirt (lg. t-shirt works best) 4 sharpened #2 pencils 3 glue sticks (large size) 1 large pink eraser 1 blunt/round tip scissors (Fiscar) 1 glue rag (old wash cloth) 2 dry erase markers
1 watercolor paint set (l6 ct) Girls – 1 box quart size Ziploc bags 1 folder w/pockets (no binders) Boys – 1 container of wet wipes
1 large school box or plastic container with snap on lid (11” x 6” approx. size) Plastic shoe boxes with a snap on lid work great!
Glue and crayons are provided!
Please put name on each item except the ziploc bags, markers, and wipes!
GRADE 1 GRADE 2 1 back pack 1 back pack 3 packs of sharpened #2 pencils 4 #2 pencils 2 large pink erasers 2 pink large erasers 3 Elmer’s glue (4 oz.-white only) 1 8 oz. Elmer’s glue (white only) 1 pointed scissors (Fiskar) 1 pointed scissors (Fiskar) 4 boxes of 24 ct. crayons 1 box of 24 ct. crayons 1 Crayola watercolor paint set (16 Ct.) 1 Crayola watercolor paint set 1 paint shirt 1 folder w/pockets (no binders) 1 clean white t-shirt (label w/name) 2 boxes of 200 ct. tissues 6 glue sticks (white only) 1 paint shirt (label w/child’s name) 1 one subj.spiral notebook -narrow line(no wireless or perforated) 1 glue rag (wash cloth size) 2 boxes of kleenex 2 glue sticks (white only) 3 dry erase markers 2 one-subject spiral notebooks -wide ruled 1 highlighter (no wireless or perforated) 1 pencil bag big enough for 1 of each supply 1 set of colored pencils GIRLS – 1 Clorox wipe container 2 dry erase markers BOYS – 1 box of Ziplock sandwich bags 1 school box
GRADE 3 GRADE 4 1 school bag/back pack 1 school bag 10 sharpened #2 pencils & 2 large erasers 8 #2 pencils 2 large glue sticks (white only) 2 large erasers 1 pointed scissors (Fiskar) 5 large glue sticks 1 box of 24 ct. crayons 3 pkgs. 3x3 sticky notes (boys only) 1 set of colored pencils 1 box gallon Ziploc bags (girls only) 4 red ink pens 2 pkgs. 3x5 index/notecards (100 count each) 8 dry erase markers 1 set of 24 colored pencils 2 one-subject spiral notebook (wide ruled) 2 boxes of 200 ct. tissues 2 boxes of 200 ct. tissues 8 dry erase markers 1 box sandwich size Ziploc bags 2 highlighters 1 wash cloth 1 washcloth 1 box 24 count crayons 1 pointed scissors (Fiskar) 2 Spiral Notebooks (no perforated pages) 2 pkgs. wide ruled loose leaf notebook paper
GRADE 5 GRADE 6 1 zippered pencil bag (no boxes) 1 zippered pencil bag (no boxes) 8-12 red pens 8-12 red pens 24 #2 pencils 24 #2 pencils 1 eraser 1 eraser 4 dry erase markers 4 dry erase markers 2 highlighters 2 highlighters 2 1 subject notebooks for Math & Reading 2 1 subject notebooks for Math & Reading 1 box of colored pencils 1 box of colored pencils 1 glue stick 1 glue stick 2 pkgs. wide-ruled loose leaf paper 2 pkgs. wide-ruled loose leaf paper 1 scissors 1 scissors 3 brown paper bags to be used for book covers 2 boxes of tissues (no store bought fabric book covers please) 3 pkg. 3x5 index cards for Social Studies, Math, & Science 2 boxes of tissues 1 2” 3 -ring binder with 5 or more index tab dividers - Math 1 2” 3-ring binder with 5 or more index tab dividers for Math 1 1 ½” 3-ring binder – no index tab dividers for S. Studies 1 small clear protractor for Math 1 Texas Instrument Calculator (TI-30XIIS) try to buy early! 1 Texas Instrument Calculator (TI-30XIIS) for Math 1 accordion folder with 6 or more tabs used for all subjects 1 2-pocket folder for Music 2 brown paper bags for book covers 2 packs 3x5 index cards for Math & Science (no store bought fabric book covers please) 1 accordion folder with 6 or more tabs used for all subjects 2 3x3 sticky note pads 1 3”x3” sticky note pad for Reading **PLEASE LABEL ALL FOLDERS, NOTEBOOKS & **PLEASE LABEL ALL FOLDERS, NOTEBOOKS & BINDERS WITH FIRST & LAST NAME AND SUBJECT BINDERS WITH FIRST & LAST NAME AND SUBJECT
JUNIOR HIGH & HIGH SCHOOL SUPPLIES
The school has purchased color-coded, 3-ring binders, for 7th
graders that will be included in the book bill and
given out the first day of school. No spiral notebooks will be needed. You will need loose-leaf notebook paper
for the binders. 8th grade students are expected to use last year’s binders or purchase new color-coded binders
on their own: Math-black; Social Studies-white; Science-green; English-red; Reading-blue. An assignment
book is required for all junior high and high school students and will be provided by the school. A basic
calculator is needed for science. Language Art supplies needed for the first day of school: blue, black, & red
pens; pencils; 2 highlighters in different colors; 1 package 3x5 ruled index cards; loose leaf paper; 12-ct. or
more crayons, markers, or colored pencils; pencil bag; and 2 erasers; 1 box of tissues - 8th
Gr. to Mr. Doseck &
7th
Gr. to Mrs. Langston.
Grade 7 General Music: 3 ring binder w/pockets on inside front & back cover, notebook paper, and
highlighter. Bring first day of class.
Grade 7 Math: Pencils with erasers, TI-30XIIS Calculator
Grade 7 & 8 Band: 3” binder w/ pencil pouch. pencil & highlighter
Grade 8 American History: 1” white 3-ring binder
Earth & Space Science, Chemistry, & Physics Classes: 1 pack (25 pages) of graph paper; scientific or
graphing calculator; and 1 notebook.
AP/DE Chemistry: 1 composition book, graphing calculator preferred
Grades 7-12 Art: All art students in grades 7-12 will have art notes and various handouts throughout the
semester or year. Please purchase: 1 folder with pockets and fasteners for each Art class you are
taking to hold hole-punched papers; and 1 pink or white eraser. All art students in grades 3-12
will need 2 #2 pencils (not mechanical) w/name on them. This pencil will be left in the room.
All Computer Application 1 Students: 1” binder
ATTN: HIGH SCHOOL MATH STUDENTS
Beginning with the fall semester, teachers and students will be using graphing calculators in their Algebra
II/Pre-Calculus, Probability, Trigonometry, and Calculus classes. Teachers will be using Texas Instruments TI-
84 (Plus or Silver edition) graphing calculators in their demonstrations/lessons. Although we recommend these
calculators, students may purchase the graphing calculator of their choice, knowing that our demonstrations will
be on the above mentioned calculators. We need each student to have his or her own personal graphing
calculator for use at school and at home to increase proficiency and comfort level with this tool. We
recommend that you purchase a TI-84 Plus or Silver edition for your child. These calculators cost
approximately $130, but they usually go on sale in July for $80 - $90 at Office Depot, Staples, Walmart, Target,
etc. If you check the Texas Instruments website in early July, you can often find a coupon that will allow you to
purchase a calculator at half-price. You might also check alternative sources such as eBay, Craigslist, etc.
The reason we chose the TI-84 calculators is because they are upgradeable, user friendly, and students can use
them during their college careers as well. It is important to note, too, that graphing calculators like the TI-84 are
permitted for use on the SAT and ACT exams and are permitted or required on several Advanced Placement
(AP) exams (this is not true for the TI-89 calculator).
Student Pictures and Fall Sports Pictures are Scheduled
Student pictures are scheduled for Friday, September 12. A letter and picture packet will be sent home with all
students prior to the day of pictures. Picture retake day is Friday, October 17.
At the beginning of each sport season, a photography company will take team pictures for the Russia yearbook.
Parents and students may also purchase pictures at that time. If you want either an individual picture or a team
picture of your child, be sure to have them bring home a picture envelope so you can place your order. Just fill
out the information on the envelope, enclose the correct amount owed, and give it to the photographer the day of
the pictures. Fall sports pictures will be taken on Friday, August 15, beginning at 2:00 p.m.
Family Educational Rights and Privacy Act (FERPA)
Russia Local School is required to provide annual notice to parents regarding student records and the rights of parents under FERPA. The information in this notice is also included in the student handbook. Cumulative records for all students are maintained at Russia School and the Shelby County Board of Education. This includes directory and confidential information. Directory information includes such items as, student name, address, phone number, date and place of birth, major field of study, extra-curricular participation, dates of attendance and graduation, awards and honors received. Confidential information includes test scores, psychological reports, behavioral data, disciplinary records, and communications with family and outside service providers. Directory information can be provided upon request to any individual. In compliance with the Family Education Rights and Privacy Act, parents may refuse to allow the Board of Education or its employees to disclose any or all of such directory information upon written request. Students and parents have the right to review and receive copies of all educational records; a copying fee may be applied. Parents have the right to request an amendment to student records. Student records may be viewed by teachers and other school personnel without the consent of the student. Individuals have a right to file a complaint with the United States Department of Education if they believe the district has violated the Family Education Rights and Privacy Act. For further information on directory information, student records, the Family Education Rights and Privacy Act, please call the superintendent. If parents wish to refuse to allow the district to disclose any or all of such directory information, written notice is required within the first two weeks of school. If a parent would also wish to refuse to allow the district to release or publish their child’s photograph/image on the district website, yearbook, press releases, athletic programs and all school publications, written notice is required within the first two weeks of school.
PICTURE FOR YEARBOOK AND HALLWAY COMPOSITE YEARBOOK STAFF REQUESTING EMAIL ADDRESS
BABY PICTURE FOR YEARBOOK
ALL SENIORS WILL GET A PROFESSIONAL PICTURE TAKEN BY LANGE PHOTOGRAPHICS ON
FRIDAY, AUGUST 15th
STARTING AT NOON. THIS IS THE DAY OF THE BAND AND SPORTS
PICTURES, SO MANY OF YOU WILL ALREADY BE HERE. ALL SENIORS WILL BE EMAILED
INSTRUCTIONS ON HOW TO SIGN UP FOR THEIR PICTURE ON AUGUST 15th
AND A “ONE
CALL” WILL NOTIFY YOU WHEN THIS EMAIL IS SENT. WE WILL BE USING THE EMAIL
ADDRESS THAT WAS GIVEN TO THE SCHOOL OFFICE DURING BOOK FEES WEEK LAST YEAR.
IF A RETAKE PICTURE IS NECESSARY, THIS PICTURE WILL BE TAKEN ON FRIDAY,
SEPTEMBER 12th
.
Boys need to wear a dress shirt, tie, and suit jacket. Girls need to wear a dress or nice top/blouse. Remember
all need to be school appropriate. The picture will be used for the yearbook and will be available for the senior
class video.
It is very helpful for the yearbook advisor to have your current email on file. This is the fastest and most cost
efficient way to get information out to you and back to the yearbook throughout the school year. Please email
the yearbook with the email you wish to use to contact you with information for the upcoming school
year. Please make sure it is one that you check regularly as this will be the only form of
communication. [email protected] Any questions or concerns contact the yearbook advisor Mrs.
Booher at the email address listed above.
Incoming seniors: a baby picture is due to the yearbook advisor by OCTOBER 31, 2014.
We will be accepting pictures from other photographers for the hallway class composite. These pictures
must be a “head shot” facing mostly forward, with nothing else in the picture i.e. no hands, logos, props etc. and
preferably not a white background. If no picture is submitted or a picture that doesn't meet the requirements is
submitted, we will default back to the Lange picture for the class composite. More specific information will be
included in the email. All professional photos need to be submitted by December 1, 2014.
Community Usage of School Facilities
Community members and organizations who wish to use any of the school facilities are reminded to contact the
office to request the usage and to complete a facilities agreement. The facilities agreement is located on the
school website. This is necessary to avoid conflicts in scheduling as well as to ensure the security of our
facility. Any questions regarding this area, please call the superintendent.
STUDENT HANDBOOKS AND SIGN-OFF FORMS
Student Handbooks will be available for families to pick up during book fees week. The handbook is available
on the school’s website at www.russiaschool.org. The Handbook / Email Address / Internet & Image Sign-Off
Forms will also be available during book fees week or it can be found under “forms” on our website. Print,
complete and turn one for each child in to the school office.
PARENTS OUT OF TOWN DURING THE SCHOOL YEAR
When both parents are out of town, please send a note to the office indicating who your child(ren) will be
staying with and who you want us to contact in case of an emergency, along with their telephone numbers.
Children sometimes stay with someone who is not always listed on the emergency medical form.
* *ATTENTION FAMILIES WITH CHILDREN IN RUSSIA SCHOOL* *
Russia School is continuing to work on ways to utilize the technology available to communicate effectively and
efficiently with our district. We believe that many families with children in our school have access to the
internet and email.
The student handbook/email addresses/internet & image sign-off form and youngest information will be
available during book fees week beginning August 4th
. One form must be completed on each student. Return the
completed form either to a teacher or to the office by the end of the first week of school.
Families with internet access will be asked to submit one email address. Please list this email address on all of
your children’s forms. You will also be asked to complete “youngest information for emailing.” Here is an
example of how to compete this form. Mr. & Mrs. Smith have children in grade levels 5, 7 and 9. The fifth
grader will be marked youngest K-6; the 7th
grader will be marked youngest 7-12; the 9th
grader will be marked
not youngest 7-12. Anytime your email address changes, notify the school office immediately so
communication between you and the school does not stop.
One section of this form pertains to your child using the internet & your child’s image being posted on the
website and/or in any local media & papers with or without their name. Please review this information.
Authorization to release contact information for the Russia Homecoming Festival is included on this form. By
marking the box, this allows the school to give student names and phone numbers to the festival committee for
the worker’s list. (The festival donates money to different organizations within our school at a later date).
The “One Call Now” communication system has been a valuable tool between the school and the families with
children in school. If your telephone number gets changed or disconnected at any time, please update this
information by contacting the school office at 526-3156.
If you have any questions about the student handbook/email addresses/internet & image sign-off form or the
“One Call Now” system, please contact the office. Thank you for your cooperation in getting this info to the
school.
MUSIC NOTES…
The summer is a good time to give that instrument a cleaning and get those needed repairs done. Please try to
have repairs done BEFORE you come back to school. Most companies take a week to do repairs. Have a safe
and musical summer!
Instruments for Sale: Please contact Mr. Fulk via email at [email protected] by August 15th
to be
placed on this list. This list will be shared with the incoming 5th
grade band members. Include name, phone
number, type-of- instrument, brand name and price.
Instruments to Donate: The music department will take all donations. These instruments can be cleaned and
given to a needy family. Contact Mr. Fulk at [email protected] or call the school to make a donation.
Band Fees:
The fees for band members in grades 6-8 are $15.00 and the fee for high school band members is $30.00.
Instrument Rental Fees: Are still $25.00 and are due with the contract paper by the start of school for high
school band. Instrument rental fees for band members in grades 6-8 are due by August 29th
. Please make
checks payable to the Russia Music Boosters.
Supplies: The music department will no longer sell reeds, oils or supplies on loan. Students can pay in
advance with a check or cash. Students can still purchase a Music Money card and get their supplies that
direction. Remember you can always visit the Rettig Music Store Website at www.rettigmusic.com and order
needed supplies. They can send them along with our sales rep on Thursdays and you will not have to pay
shipping. You can also order by phone at 1-800-52-MUSIC.
Russia Summer Schedule: HS Band 2014
Everything underlined is a graded rehearsal/performance. Make-up practice charts will be required if you miss.
Other rehearsals are not mandatory, however you must turn in a note from a parent in order to be absent for a
vacation. Summer help times are posted below. Students can earn 30 minute passes with a donation of time on
summer help times or by donating 2 boxes of tissues to the organization. Freshmen should have ordered items
through Rettig Music by this point. See freshmen packets for other information. All summer calendars are
posted outside the music room on the bulletin board.
Our Schedule is:
BAND CAMP: July 28th
though July 31st: Band Camp 8AM- 2PM Monday through Wednesday. &
Thursday we perform at the Ohio State Fair (See Tentative Breakdown below)
August 4th
: Full Band 7-9PM Monday
August 6th
: Full Band 7-9PM Wednesday
August 11th
: Full Band 7-9PM Monday
August 13th
: Full Band 7-9PM Wednesday
August 14th
: Full Band Chairplacement /Thursday
Band Pictures: Friday Aug 15th
at 1:00pm SAME DAY AS FALL SPORT PICTURES
7-31: Ohio State Fair - parade - summer uniform
8-17: Bremanfest Parade – summer uniform
Russia Homecoming Performance – sumer uniform 8-30
Fall Fest performance at Lake Loramie State Park – concert not a parade 9-14
Bradford Pumpkin Show Parade 10-7
Possibly: Minster Oktoberfest in October (Sunday)
District 11 OMEA Honors Band and Capital Honors Band TBA (November)
Christmas Concert 12-15
BG Honors Band 1-16?
HS solo and Ensemble TBA
Winter Concert 3-2
JH Solo Pops 4 ? TBA
JH Solo and Ensemble 4 ? TBA
ONU Honors Band 4 ? TBA
Shelby County JH Honors Band TBA
Spring concert 5-11
Graduation 5-24
6th
Grade Band and JH Band:
Summer rehearsals are as follows:
August 18th
: JH Band from 2 to 3:30 and 6th
grade band from 4:30 to 6PM. New folders, music and instrument
slots will be passed out. Please let Mr. Fulk know if you can’t attend.
5th
Grade Band Sign-Up:
Meeting will be on August 19th
at 7:30 PM in the music room. A mailing will go out to all upcoming band
members. Band fittings will be August 4th
, 6th
and 11th
from 3PM to 6PM. Information on how to sign up for
the fittings will be in your mailing. Forms for band are due from August 9th
to 16th
. I will be ordering your
child’s books this year. There is a $15.00 book fee for this class.
After School Lessons for 5th
Grade Band Only:
Begin September 8th
and run through October 31st. Eight weeks.
Information will be given out to the band members on days and times
Coming soon in the mail will be the Annual Music Booster Donation Drive. We want to thank everyone in
advance for their contributions and donations.
If you haven't gotten your band calendar ordered please contact Jackie Frazier at 526-9009 to place your
order. Or check out the school website and download a form. We know that some normal buyers were missed
this year. Our sales are down by 100 calendars. Booster officers are making up the volleyball and basketball schedules for the concession stand. Contact a
booster officer if you are interested in working a specific date.
President: Jenny Busse
Vice President: Beth Sherman
Secretary: Mike & Dee Adams
Treasurer: Jackie Frazier
DEVELOPMENTAL SCREENING INFORMATION
One Friday each month, developmental screenings are scheduled at the Wee School (498-0101) for children
ages birth through age 2 and are also scheduled at Shelby Hills (498-4565) for children ages 3 to 5. Screenings
are free of charge. If you have any concerns or questions about your child’s development, please call to
schedule an appointment.
END OF YEAR TESTING PICK-UP
(Achievement Test Results for Grades 3-8)
Test results are available for pick-up at the school through book fees week.
JUNIOR CLASS MAGAZINE FUNDRAISER
The Junior Class Magazine sales kick off meeting is Friday, August 29. This fundraiser will run until Sept. 12.
All sales must be turned in by 8:00 AM on the 12th
. If you are interested in purchasing any magazines, music
selections or children’s books and no one has contacted you, please call the school office prior to Sept. 12.
The 2014-15 School Calendar has been posted to the school website.
Immunization Waiver/Exemptions Update from the
Sidney-Shelby County Board of Health
Parents who have signed waivers exempting their children from immunization requirements must re-sign a
waiver form every year. Blank waiver forms will be available during book fees payment week and at the Board
of Health office. Questions concerning the re-signing can be addressed by calling Michelle Detrick, RN,
Immunization Coordinator for the Board of Health at 937-498-7249 or Mr. Rose in the school office.
ABSENCE FORM WALKER / BUS CHANGE FORM
(All students) (All students)
The “Absence and Walker/Bus Change Form” dated 10/2010 (date posted at the bottom of the form) is
available on our school website under “Forms.” When printing this form (2 forms per page), you may have
to make an adjustment on your computer so the forms prints on one page. These forms will also be available
during book fees week and throughout the school year in the office.
Since all pertinent information is on this form, Russia School would prefer that a parent/guardian use the
“Absence and Walker/Bus Change” form for all student absences and bus changes for all students K-12.
However, for student absences the school will accept a telephone call from a parent/guardian or a signed &
dated note from a doctor.
It is extremely important that you complete “all required information” when filling out this form. All forms
are due by the start of the school day. Students in grades K-6 should turn this form into their homeroom
teacher; students 7-12 turn their form into the office. Make as many copies as you want, cut in half and send
one form into school with your child. Students in the same family in grades 7-12 can be on ONE form
together if they are absent the same date.
The “absence” portion of this form is being used to streamline the process of reporting an absence for
parents and for the school. The form includes all the essential information that we need to record your
child’s attendance.
The “walker/bus” section asks for the necessary information to safely get your child to their destination per
your request. The only way we can honor your requests is to have all the information. Complete all the
information in this section so that this can be shared with teachers, office staff and bus drivers. Do not skip
the “Riding Bus #” and/or “Not Riding Bus #” part(s) if this pertains to your situation. If your child walks to
a different location, please complete this form. Please remember to limit walker/bus changes due to child-
care needs and for emergencies only. Make other arrangements for birthday parties, social events, etc. When
our buses leave school in the afternoon, they are usually filled to capacity. We do not want a bus to be
overcrowded and leave any student without a seat at any time on the route. Any questions, contact the
superintendent.
Thank you for helping us to improve the efficiency and safety of the students of this district.
Nurturing Network Club
In September, the Russia Nurturing Network (Mother’s Club) will begin a new year. The purpose of the
Nurturing Network is to promote spiritual, mental, physical, and moral development of our children and the
children of our community, and to promote good fellowship among our families. Our fundraisers included a
flower sale and bake sale. Our community services included providing meals for the teachers during parent-
teacher conference, serving refreshments at the Catholic Crib lighting, and baking Christmas cookies for the
senior citizens in our community. Recipients of our fundraisers were sponsoring a child in Haiti, Russia Library
(summer reading program), community organizations, and support to local families. The officers for the
upcoming year are: President-Ann Delaet, Vice President-Carla Meyer, Secretary-Gina Poling. Treasurer-
Deanna Ball, and Chaplain-Brenda Goubeaux. We want to thank the school and community for their support of
our club. If you are interested in learning more about Nurturing Network, please contact a club member or
officer.
Charitable Organizations
Each year charitable organizations, such as the Salvation Army, contact the school in the summer and again at
Christmas time to ask for the names of families in need of help with school supplies, Christmas needs, etc.
Please contact the school office at 526-3156 if you would like your name released to these organizations.
NATIONAL HONOR SOCIETY
Inductions for the Russia Chapter are held in November for eligible juniors and seniors with a GPA of 3.4.
Requirements and standards for the Russia School Chapter of the National Honor Society may be viewed from
the Russia School web page by selecting ACADEMICS/NATIONAL HONOR SOCIETY. If you have any
questions regarding requirements please contact the school office at 526-3156.
NEWS FROM THE ATHLETIC DEPARTMENT
Important Dates and Information for all Athletes:
Fall Sports Pictures Fri, August 15, 2014 1:00 pm Band; 2:00 pm all other sports
Winter Sports Pictures Fri, November 7, 2014 8:00 am
Meet the Team Night Sun, November 16, 2014 4:00 pm
Spring Sports Pictures Fri., March 20, 2015 3:15 pm
Fall Sports Program Tue, November 4, 2014 7:00 pm
Winter Sports Program Mon, March 9, 2015 7:00 pm
Spring Sports Program Mon, May 18, 2015 7:00 pm
August 1 - First day of practice for all fall sports
August 3 - Fall Sports Parent/Coach/Athlete Meeting, Clair C. Naveau Gym, 6:30 pm
October 26 - Winter Sports Parent/Coach/Athlete Meeting, Clair C. Naveau Gym, 6:30 pm
October 31 - First day of practice for girls basketball
November 7 - First day of practice for boys basketball & bowling
January 9 - Homecoming Game
January 10 - Homecoming Dance
February 23 - First day of practice for baseball & softball
March 1 - Spring Sports Parent/Coach/Athlete Meeting, Clair C. Naveau Gym, 6:30 pm
March 9 - First day of practice for track
Student/Athlete Physical Information
All athletes must have their approved physical, signed training rules, and completed emergency medical
forms turned in before they are permitted to participate in any practices, scrimmages, or games during the
2014-15 school year. No exceptions shall be permitted. Forms can be found on the school website or in the
school office.
$20 Participation Fee
Please be reminded that all students need to turn in their $20 participation fee for fall sports by the 5th
day of
practice or at the Fall Sports Parent/Coach/Athlete Meeting on Sunday, August 3rd
at 6:30 p.m. This is a per
student per season fee.
Athletic Ticket Prices
Athletic ticket prices can be found on the school website at:
www.russiaschool.org/departments/athletics/tickets
Senior Citizen Passes
Russia School issues senior citizen passes for all home athletic events. If you are eligible for a senior citizen
pass and do not have one, please call the school office and we will prepare one for you. The pass will be good
for the remainder of your years living in Russia. If you lose your pass, please contact the school office.
A pass will admit you into all activities (sports events, senior class plays, musicals, etc.) at no charge. The
criteria for obtaining a pass is as follows:
1. Bearer must be 62 years of age or older.
2. Bearer must be a Russia Local School District resident.
3. Pass is not transferable.
4. Pass is honored at Russia home activities only.
5. Pass is not honored at tournament games held in Russia.
2014-15 A.M. Bus Routes Bus: #1 Carrie Heuing
Stops 1. Dan Hoying – Makena & Saige 2. Brian Schulze – Zeb 3. Chad McClenen – Isabelle, Kaylina, Lillianne 4. Trevor Casto – Eliza 5. Mike Adams – Elizabeth 6. Chris Tebbe - Cole 7. Steve Bohman –Luke, Emily, Max, Benjamin 8. Mike Hoying - Gavin 9. Mark Hoying - Adam, Rachel 10. Sean Westfall – Vanessa, Jarrod 11. Ryan Carter – Zachary, Jacob, Hannah, Emma 12. Steve Simons - Cole 13. Chris Art – Rebecca, Peter 14. James Apple – Faith, Nathan & Kelsey Myers 15. Dan Michaels – Kassie Harvey 16. Jason Drees – Jordan 17. Dale Goubeaux – Greg, Jacob 18. Phil Coverstone – Brant, Evan, Kayla 19. Ron DeLoye - Andrew 20. John Klosterman – Natalie, Brooklyn
21. Dan & Nicki Nichols – Shane Mueller 22. Suzette Vastano – Gunnar, Lindsey 23. Deb Barhorst – Kody 24. Dan Millhouse – Kennedy & Connor Metz 25. Greg Pleiman – Jacob 26. Scott Voisard - Karissa, Kenzi 27. Frances Mesler – Joshua 28. Tim Grogean - Noah 29. Mark Shappie – Aiden, Zane, Jaela 30. Tammy Heaton – Cody, Zachary Edwards 31. Ken Gariety – Allison, Audrey, Alana 32. Brad Heaton – Luke, Lauren 33. Jonathan Keller – Waylon 34. Andy Sherman – Kylee, Drew, Victoria 35. Mike Meyer – Claire, Anna 36. Greg Gariety – Jordan, Justin, Jake, Eliza
Bus: #2 Angie Lachat
Stops . 1. Ben Williams – Cole 2. Mike Drees - Zachary, Noah 3. Randy Seger – Alex, Justin, Becca 4. Jesse Pohlman – Bailey,Shelden 5. Angela Lochard – Austin Poeppelman, Blake, Braden 6. Doug Sherman - Hannah, Chloe, Jackson, Abigail 7. Matt Cordonnier – Xavier, Cyril 8. Kathy Schwartz - Megan 9. Scott Phlipot – Xavier 10. Ken York – Joshua, Mary, Lily, Elijah & Jonah 11. Phil Albers - Trevor, Savannah 12. Jason Grillot – Abigail 13. Aaron Monnin – Brayden, Landon 14. Jeff Poeppelman – Grace, Alyssa (K-AM) 15. Tom Luthman - Brandon
16. Rodney Counts - Jonah, Claudia, Owen, Jude, Leo 17. Al Puthoff - Dion, Simone 18. Jamie Magoto – Sayer 19. Steve Bergman - Joshua 20. Ken Bergman – Zachary 21. Ed Petty – Carrie 22. Dale Alt - Drew 23. Chad Bornhorst – Danny Goins, Brock, Audra (K-AM) 24. Jeff Hoehne – Ella, Adam, Claudia 25. Aaron Seger –Alex, Ajay, Max 26. Ed Monnin – Julia, Andrea, Jenna 27. Diane Magoto - Jason, Kelsey, Alyssa 28. Dan Poling - Hannah, Drew, Laurissa, Jared, Veronica 29. Tom Francis - Sawyer, Tomasina 30. Pat Rosenbeck – Gage, Mallory
Bus #3 Tom Gariety
Stops . 1. Jason Gaerke – Erin,Christina,Sam,Alexandria,Jayden 2. Brad Armstrong – Elli 3. Matt Holscher - Amber 4. Wm. Gerdes – Emma 5. Dave Meyer – Brooklyn, Allie (K-AM) 6. Jason Holscher – Dameon H., Marissa, Grace, Ashley 7. Jenni York – Evan 2420 St. Rt. 47 8. Keith Kittel – Jacob, Breanna 9. Mark Ball – Caleb 10. Rick Ball - Andrew, Jordan 11. Steve Gehret - Jayden 12. Dave Borchers – Lauren 13. Matt Hiatt – Kaylee, Braden, Seth 14. Jim Luthman – Dawson 15. Jim Langenkamp - Rudy 16. Tony Luthman - Danielle 17. Tim Wenrick – Morgan, Mackenzie 18. Lori Ditchkus – Cassidy, Henry 19. Kent Borchers – Bernadette 20. Tony Cox - Christian 21. Rob Phlipot – Laci, Kourtney 22. Dan Overman – Tyler
23. Thad Monnin – Croix (K-AM), Sebastian (K-AM) 24. Danny Schneible – Hannah 25. Tim York - David, Rachel, Jordan, Benjamin 26. Ryan Bensman – Jacky, Allison 27. Rob Saunders – Grace, Grant, Camille 28. David Kremer - Jordan 29. Mike York – Michael, Jess, Sam, Jenna, Faith 30. Dustin Schmerge – Kaleb, Tyler, Andrew 31. Eric Rinderle – Ben 32. Tom Heitkamp – Claudia, Hanna, Lillie 33. Gery Heuing - Rachel, Mitchell
Bus: #6 Mike Meyer
Stops 1. Jim Lloyd – Hunter, Callie 265 W. Main St. 2. Kyle Slade – Tucker Wolaver, Dawson 3. Andy Baugher – Ava 4. Jason Scott – Tyler, Ashley, Carley 5. Ryan Whittaker – Kaiden 6. Alex Monnin - Trevor, Trenton, Lauren, Caleb, Alexis 7. Craig McEldowney – Claira, Emmie Smith (K-AM) 8. Chris George - Alicia, Clay, Gavin 9. Chad Delaet – Emma, Casey, Levi 10 Phil Stickel - Joseph, Audrey 11. Robert Osborne – Destiny, Rebecca, Jalynn 12. Brian Pinchot – Becky, Sarah 13. Eric Voisard - Max, Audrey, Grace, Isabel, Michael 14. Joe Oen – Eddie 15. Amber Ford – Vanessa, Rallie Wirrig (K-AM) 16. Aaron Schmitmeyer – Jacob, Elijah (K-AM) 17. Derron Wilson - Kylie, Cameo 18. Dave Dahlinghaus – Luke 19. Ben York – Leanne, Ben
20. Shane Borchers – Cece, Vince, Celestine (K-AM) 21. Jeremy Monnin – Lexi, Kendall, Miah, Grace 22. Josh Francis – Sophie, Felix 23. Dan Magoto - Ryan, Lee 24. Dan Francis – Leah 25. Andy Meyer - Lindsay, Jordan 26. Aaron Cordonnier – Austin, Elijah (K-AM) 27. Sean Westfall - Vanessa, Jarrod 28. Andy Busse - Derek, Lukas, Jordan 29. Alan Monnin – Joseph 30. Jerold Barlage - Kara 31. Doug Koverman – Kelsey, Brandon; 32. Jim Heuing – Katelynn, Tori
Bus Route Information
If you are expecting to have your children picked up or dropped off at a babysitter, please fill out the
form below and submit it to the school office during the week of book fees collection or no later than
Friday, August 8th. Even if your babysitter information has not changed from last year, you still need to
complete this form. Kindergarten parents do not need to complete this form unless there has been a change
since providing this information at the kindergarten screening. If the information is not submitted by the
deadline, there is no guarantee that your child will be picked up or dropped off at the babysitter. If your
situation changes after submitting this form, please contact the school office.
Throughout the school year, remember to send an “Absence Form / Walker/Bus Change Form” in advance to all
teachers if your child is not riding the bus to their usual destination after school. Please refrain from last minute
changes unless an emergency arises. If you have a change in the morning pick up, please call the school before
7:10 a.m.
Cut here
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Please list below the names and grades of your children going to a babysitter:
Child’s Name ____________________________________________ Grade (’14-‘15)__________
Child’s Name ____________________________________________ Grade (’14-‘15)__________
Child’s Name ____________________________________________ Grade (’14-‘15)__________
Parent’s Name ___________________________________________________________________
Home Address ___________________________________________________________________
Home Phone Number __________________________ Cell Phone Number _________________
Work Phone Number _____________________________________________________________
Babysitter’s Name _______________________________________________________________
Babysitter’s Address _____________________________________________________________
Babysitter’s Phone Number ________________________________________________________
Please circle the appropriate days of the week the child will be going to the sitter:
Child(ren) are to be picked up at home: Everyday M T W TH F
Child(ren) are to be picked up at sitter: Everyday M T W TH F
Child(ren) are to be dropped off at home: Everyday M T W TH F
Child(ren) are to be dropped off at sitter: Everyday M T W TH F