la cima bilingual leadership campcima+complete+packet.pdf · la cima bilingual leadership camp 2018...
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QUESTIONS?
Registration questions: Melissa Rossell
360.497.5323 [email protected]
Curriculum questions: Vincent Perez
318.510.1936 [email protected]
Bilingual contact: Travis Ruhter
360.244.9601 [email protected]
La Cima Bilingual Leadership Camp Sponsored by the Association of Washington School Principals
June 25 - June 30, 2018 ~ Cispus Learning Center
Program Overview
We impart leadership and life skills to Latinx youth in Washington State
What is La Cima Leadership Camp? The Association of Washington Student Leaders is committed to Latinx students in Washington. At La Cima, students participate in a leadership curriculum that is recognized nationally as a model of excellence. Through an interactive, bilingual, weeklong camp experience, students learn and practice essential skills such as teambuilding, communication, creative thinking and public speaking. The program is facilitated and supervised by staff of the Association of Washington School Principals, and composed of teachers, counselors, administrators, professionals and college-age role models dedicated to serving Latinx youth. Who should attend? La Cima is designed for Latinx high school students entering grades 9-12 who wish to make a positive difference in their schools and communities. La Cima is not a language camp. We seek students with a broad range of leadership experience and skills - from high performing to those with untapped potential. These student leaders can be elected, appointed or recruited. La Cima also encourages ASB officers from schools with a large Latinx population to attend. There is a limit of 12 students per school, and no more than three of these 12 students may be previous participants at La Cima Leadership Camp. What language is spoken at camp? Leadership lessons are conducted in both English and Spanish. The camp atmosphere is open and welcoming to students who are fluent in both languages as well as students who only speak English or Spanish. The camp is staffed with adult leaders from all parts of the linguistic spectrum. What about transportation? Charter bus service to and from Cispus Learning Center in Randle is available for an additional fee. Students can also be transported to camp by their school, sponsor or parent. Student drivers are NOT allowed.
What is the cost? The cost for students coming from schools that are members of the Association of Washington Student Leaders is $260 (non-member schools, $275). Not sure if the student’s school is a member? Call 360.497.5323 or email Melissa at [email protected]. How do I register students? Both schools and sponsoring agencies can register students for La Cima Leadership Camp. The registration process consists of four steps: 1. Complete the School or Sponsoring Agency
Registration Form to secure a spot at camp for your students. Mail, fax or email with payment information, before camp fills!
2. Provide the student leaders with the Delegate Registration/Medical Form to complete. It must be completed and signed by principal/adviser, student and parent, and mailed to AWSL by May 15.
3. As the date of camp nears, continue to connect with the student leaders to reassure them of their choice to attend the life-changing experience of La Cima.
4. Verify their transportation arrangements. Students are either signed up for our charter bus service or they are transported to camp with an adult driver.
Association of Washington Student Leaders Phone (360) 497-5323 • Fax (360) 497-5324
www.AWSLeaders.org
La Cima Bilingual Leadership Camp 2018 Sponsored by the Association of Washington School Principals June 25 – 30, 2018 at Cispus Learning Center, Randle WA
Registration Details
Reserve Your Spaces On a space available basis, from February 1 - May 15, schools and sponsoring agencies may reserve delegate spots with a School/Sponsoring Agency Registration Form and purchase order or payment. All spaces cancelled after May 15 will result in a non-refundable fee of $75. Delegate Forms should be mailed as soon as collected but no later than May 15.
Delegate Forms Register only students who can commit to their camp session from start to finish. Please verify that Delegate Registration/ Medical forms (available in both English and Spanish) are legible and signed by parents and students.
Collect, sign and mail forms as a packet by May 15.
DO NOT FAX delegate forms.
Delegate forms should be mailed as a packet to: AWSL, 2142 Cispus Rd., Randle, WA 98377.
Forms can also be scanned (color scan preferred) and emailed to: [email protected].
Delegation Size No more than 12 delegates may be registered from the same school. In addition, no more than three delegates per school may be previous participants at La Cima Leadership Camp.
Regsitration Cost Registration is $260 per delegate for students from schools that are members of the Association of Washington Student Leaders. The non-member delegate rate is $275. Charter bus service is available for an additional fee. Transportation
1. Schools may use the charter bus service arranged by the Association of Washington School Principals. Delegates riding the bus should plan to ride round trip. Students using our bus service will be mailed a copy of their pickup location and departure time approximately one week prior to their camp session.
2. Delegates may be transported to leadership camp by a school official, a parent or an adult authorized by the school. STUDENT DRIVERS ARE NOT ALLOWED.
3. Charter bus routes are created based upon school requests at time of registration. Not all of the following stops may be available for La Cima.
Auburn $64 Ellensburg $65 Olympia $62 Tri-Cities $68 Bellevue $66 Everett $68 Renton $65 Vancouver $65 Bellingham $68 I-5 @ Hwy 12 $50 Seattle $66 Wenatchee $68 Burlington $68 Kelso $63 Spokane $70 Yakima $60 Centralia $58 Moses Lake $69 Tacoma $63
Cancellation Policy Schools or sponsoring agencies may cancel delegate spaces up to May 15 with a full refund. All cancellations received after May 15 will result in a non-refundable processing fee of $75 plus transportation fees. If cancellation is made less than five working days prior to camp (June 18, 2018), the full charge of camp, plus transportation will apply. Full charges will apply for delegates who leave early or do not show up for camp. All cancellations must be received in writing from a school or sponsoring agency official by the specified date.
Questions? Contact Melissa Rossell ([email protected]) or Heather Muir ([email protected]) (360) 497-5323 • www.AWSLeaders.org
La Cima Bilingual Leadership Camp Sponsored by the Association of Washington School Principals June 25 - June 30, 2018 ~ Cispus Learning Center
School/Sponsoring Agency Registration Form
School/Sponsoring Agency
Billing Address City State Zip
School/Agency Contact E-mail
Contact’s Phone Cell/Summer Phone
If contact will be unavailable after school is adjourned (i.e. vacation), please provide an alternate contact:
Alternate Contact Cell/Summer Phone Email REGISTRATION: June 25 - June 30 (Mon - Sat)
Indicate the number of delegates you are sending. Limit of 12 students per school.
AWSL Member School Delegates x $260 = $
Non-Member School Delegates x $275 = $
TRANSPORTATION: (See registration details for pick-up locations and fares)
NO transportation needed
Bus reservations: # of delegates x $ = $
Preferred Pick-Up Location
Total Registration and Transportation = $ METHOD OF PAYMENT: A purchase order or payment to “AWSP” must accompany the School/Sponsoring Agency Registration
Form. Invoices will be sent upon receipt of this registration. Adjustments to invoices will be made within the provisions of the cancellation policy.
Mail, fax or scan/email this form with payment to:
Association of Washington Student Leaders 2142 Cispus Road
Randle, WA 98377
360.497.5323 FAX 360.497.5324 [email protected]
Cancellation Policy: Schools or sponsoring agencies may cancel delegate spaces up to May 15 with a full refund. All cancellations received after May 15 will result in a non-refundable processing fee of $75 plus transportation fees. If cancellation is made less than five working days prior to camp (June 18, 2018), the full charge of camp, plus transportation will apply. Full charges will apply for delegates who leave early or do not show up for camp. All cancellations must be received in writing from a school or sponsoring agency official by the specified date.
Registration opens February 1st RESERVE your spaces now. Reservations are accepted on a space available basis.
FOLLOW-UP by May 15 with your packet of delegate forms.
La Cima Leadership Camp 2018
Delegate Registration/Medical Form Cispus Learning Center, June 25-30, 2018
Legal First & Last Name _____________________________________________________________ Preferred Badge Name_____________________
School __________________________________________________________________________________________________________________
Home Mailing or P.O. Box __________________________________________ City/State _______________________________ Zip_____________
Student Email _____________________________________________________________________ Student Cell Phone _____________________
Age __________ Graduation Year 20______ Gender: Female Male Other Birth Date - -
Parent/Guardian Name(s) ___________________________________________________________________________________________________
Parent Evening Phone _____________________________________________ Parent Day Phone _________________________________________
Alternate Emergency Contact _______________________________________ Alternate’s Phone _________________________________________
Medical Insurance Company ________________________________________ Policy Number ___________________________________________
MEDICAL INFORMATION TO BE COMPLETED BY PARENT OR GUARDIAN - ATTACH DETAIL IF NEEDED
Dietary needs: Vegetarian Peanut allergy? No
Vegan Yes, ingested
Dairy Free Yes, airborne
Gluten Free
Date of last tetanus shot: __________________________
Current medications/taken for: _______________________________________________ Dose/Time of Day: ________________________________
Can a health care professional provide over the counter medication? Yes No Restrictions: ________________________________________
Should the delegate be restricted from any type of activity? _______________________________________________________________________
Does your child need special accommodations due to physical challenges? ___________________________________________________________
Cancellation Policy. Schools or sponsoring agencies may cancel delegate spaces up to May 15 with a full refund. All cancellations received after May 15 will result in a non-refundable processing fee of $75 plus transportation fees. If cancellation is made less than five working days prior to camp (June 18, 2018), the full charge of camp plus transportation will apply. Full charges apply for delegates who leave early or do not show up for camp. All cancellations must be received in writing from a school or sponsoring agency official by the specified date.
Student Agreement: If accepted as a delegate, I agree to abide by all regulations established by the officials of the Association of Washington Student Leaders and will strive to be a worthy representative of my school by contributing my best efforts toward the success of the camp. I have read and understand the cancellation policy and I understand that student drivers are not allowed. Signature of Student _____________________________________________________________________________________________ Date ______________________ Parent or Guardian Permission: As the parent or guardian, I give my permission for my child to attend Leadership Camp at the Cispus Learning or Chewelah Peak Learning Center and I understand that this program is fully supervised by staff of the Association of Washington School Principals (AWSP). I have read and understand the cancellation policy and I understand that student drivers are not allowed. By signing this form, I give permission for photographs, slides or videos of my child to be used for information, publication, presentation or other educational purposes. I authorize AWSP to obtain medical care for my child in the event such care is necessary. In the event of an emergency, I understand that every effort will be made to contact the parent(s) or guardian of the delegate. Permission is hereby granted to the health care professional or accredited hospital and their associates to perform necessary medical procedures that are deemed essential to the treatment of the above named individual. I also agree to be responsible for the payment of such care.
Signature of Parent or Guardian __________________________________________________________________________________ Date ______________________
Race/Ethnicity (Optional) ____ Hispanic / Latino of any race(s) ____ American Indian / Alaskan Native ____ Asian ____ Black / African American ____ Native Hawaiian / Other Pacific Islander ____ White ____ Two or More Races
Other dietary, health concerns or allergies:
________________________________________________
________________________________________________
________________________________________________
Adviser or Principal Verification I recommend this student as a delegate to LaCima Leadership Camp. I understand the cancellation policy and am verifying camp dates/transportation request.
Initial and date:
DO NOT FAX THIS FORM
We impart leadership and life skills to Latinx youth in Washington State
Dear Delegates and Parents,
Welcome to the Association of Washington Student Leaders program!!! With great excitement and anticipation, camp staff looks forward to providing delegates an extremely rewarding learning experience. As a delegate you will have an opportunity to develop leadership skills, explore educational possibilities and make plans to attain your dreams. At La Cima, students participate in a leadership curriculum that is recognized nationally as a model of excellence. Through an interactive, weeklong camp experience, students learn and practice essential skills such as teambuilding, communication, creative thinking and public speaking. La Cima staff is composed of teachers, counselors, administrators, professionals and college-age role models dedicated to serving Latinx youth. Camp is a time of adventure and discovery. Although exciting, six days may feel like a long time to be away from home. Our staff is aware of the hesitation you may feel and is committed to helping delegates adjust once they arrive. The benefits of attending La Cima are many. Students leave camp feeling empowered and confident in their abilities to succeed in all areas of life. In fact, many students experience an increase in their self-esteem, honesty, expectations of their future and ability to say “No” in negative situations. As parents, we know it may be difficult to trust outside organizations to care for your child. Our number one goal is to create a safe space for students to experience personal and social growth. As a staff, we place high importance on student safety and supervision, which is why we have a number of measures in place to ensure students are well-cared for. A certified counselor and medic will be available at all times. Teachers, facilitators and counselors from around the state will supervise the students. Students will be separated by gender in the dorms. Our schedule is intentional and full. Cispus Learning Center and La Cima both operate under the umbrella of the Association of Washington School Principals, an organization that has been dedicated to providing leadership camps to high school students for well over 60 years. When packing for camp please feel free to bring musical instruments, artwork and tools, sport equipment and anything you would like to share with other delegates. You should also pack a toothbrush, toothpaste, sleeping gear (bedding or sleeping bag), a pillow, a towel, soap, shampoo, comfortable shoes, sandals, and clothing for cold and warm weather. Please pack clothes that you don’t mind getting dirty. There is no cell phone service and no Wi-Fi available at Cispus Learning Center. If you would like to be able to call home, bring a pre-paid phone card with you. The direct phone number for the learning center is 360.497.7131. Delegates may receive mail at camp if it is addressed to the delegate, c/o La Cima Camp, 2142 Cispus Road, Randle, WA 98377. The most important part is getting on the bus. Once you’ve done that, the rest will unfold. If your school/sponsoring agency requests our charter bus service, one week before camp you will be mailed a transportation itinerary with pick up and return time and location. It is possible for an adult family member to drive you to camp if that makes it easier for you to attend. However, student drivers are NOT allowed. If you have any questions or concerns, contact one of the camp co-directors:
Vincent Perez Travis Ruhter Erika Ambrocio-Vasquez
318.510.1936 [email protected] 360.244.9601 [email protected] 509-881-5987 [email protected]
Bilingual Contact: Travis Ruhter 360.244.9601 [email protected]
Association of Washington Student Leaders Phone: 360.497.5323 • FAX: 360.497.5324 • www.AWSLeaders.org
La Cima Bilingual Leadership Camp 2018 Sponsored by the Association of Washington School Principals
Campamento bilingüe de liderazgo de La Cima Junio 25 a Junio 30, 2018 ~ Centro de Aprendizaje Cispus
Matricula Delgada y Formulario Médico
Nombre y Apellido legal _____________________________________________________________ Nombre Preferido ________________________
Escuela __________________________________________________________________________________________________________________
Dirección o PO BOX _______________________________________________ Ciudad/Estado _________________________ Código ___________
Correo Electronical ________________________________________________ Número Celular ___________________________________________
Edad _________ Grado entrada el próximo ano ______ Género: Femenino Masculino Otro
Fecha de Nacimiento - -
Padre/Tutor ______________________________________________________________________________________________________________
Número de teléfono de casa ________________________ Teléfono de los padres durante el día _________________________________________
Nombre y teléfono del contacto de emergencia _________________________________________________________________________________
Compañía de seguro médico ________________________________________ Número de Póliza _________________________________________
LA CAJA ABAJO DEBE SER TERMINADA POR EL PADRE O EL TUTOR. ADJUNTE DETALLES SI ES NECESARIO.
Necesidades ¿Alergia al Nutricionales: Vegetariano cacahuate? No
Vejan Si, ingerido
Sin Lácteos Si, aerotransportado
Sin Gluten
Fecha de la última inyección de tétanos: _______________________
Medicamentos que está tomando actualmente/para que _________________________________ Dosis y horario en que lo toma _______________
¿Puede proveerle el profesional de cuidado de salud medicamento sin receta a su hijo/a? Sí No Anota las: _________________________
¿Debe de ser el delegado privado de alguna actividad? ____________________________________________________________________________
¿Necesita su hijo/a adaptaciones especiales debido a una incapacidad física? _________________________________________________________
Póliza de cancelación: Todas las cancelaciones recibidas después del 15 de mayo tendrán una cuota no reembolsable de $75. Si cancela antes de cinco días de trabajo antes del campamento, será cargada con el costo total del campamento. Serán cargadas con el costo total de delegados, aunque se vayan temprano o no lleguen. Todas las cancelaciones deben de ser sometidas por escrito por un oficial de la escuela con la fecha apropiada.
Acuerdo del estudiante: Si soy aceptado como delegado, Yo estoy de acuerdo en seguir las regulaciones establecidas por los oficiales del Programa de Liderazgo Estudiantil y trabajaré para ser un valioso representante de mi escuela al contribuir con mis mayores esfuerzos para el éxito de este campamento. He leído y entiendo la póliza de cancelación y también entiendo que.
Firma del Estudiante Fecha
Permiso del padre o Tutor: Como padre o tutor doy mi permiso que mi hijo/hija pueda asistir al Campamento de Liderazgo en el Centro de Aprendizaje en Cispus, Randle, Washington. Entiendo que este programa está totalmente supervisado por personal de la Asociación de Directores de las Esquelas de Washington. He leído y entiendo la póliza de la cancelación. Con la firma de este documento, le doy permiso del uso de fotos, videos y diapositivas de mi niño para información, publicación u otros propósitos. Autorizo a la Asociación de Directores de las Escuelas de Washington obtener cuidado médico para mi hijo/hija en caso que sea necesario. En caso de una emergencia procuraremos comunicarnos con el padre(s) o tutor del delegado. Otorgo mi autorización al profesional de asistencia médica o al hospital acreditado y sus socios para realizar los procedimientos médicos necesarios que se creen esenciales para el tratamiento del individuo denominado. Concuerdo también ser responsable del pago de tal cuidado.
Firma de Padre o Tutor Fecha
Verificación de el director de la escuela: Recomiendo a este estudiante para que sea aceptado como
delegado para el Campamento de Liderazgo. He leído y entiendo la póliza de cancelación. Mi firma servirá como verificación de la fecha del campamento y solicitud de transportación.
Initial and Date
Raza/Etnia (Opcional) ____ Hispano / Latino (cualquier raza) ____ India Americana / Nativa de Alaska ____ Asiática ____ Negra / Africana Americana ____ Nativo de Hawaii / Islas del Pacífico ____ Blanca ____ Dos o Más Razas
Otras preocupaciones dietéticas, de salud o alergias:
________________________________________________
________________________________________________
________________________________________________
Impartimos habilidades sobre la vida y liderazgo a los jóvenes latinx del estado de Washington
Delegados y Padres, ¡Bienvenidos al programa de la Asociación de Lideres Estudiantiles de Washington! Con gran entusiasmo y expectativa el personal del campamento se imagina una experiencia memorable y de gran aprendizaje. Como delegado usted tendrá la oportunidad de desarrollar habilidades de liderazgo, explorará posibilidades educativas y hará planes para alcanzar sus sueños.
En La Cima, los estudiantes participan en un programa de liderazgo que es reconocido por la nación como un modelo de excelencia. Gracias a una experiencia interactiva que dura una semana, los estudiantes aprenderán y practicarán habilidades esenciales como trabajar en equipo, comunicar, pensar creativamente y hablar un publico. El personal de La Cima está compuesto de profesores, consejeros, administradores, profesionales y estudiantes universitarios que están dedicados a servir a la juventud latinx.
La experiencia del campamento será un tiempo de aventura y descubrimiento. Aunque es emocionante, nuestro personal se da cuenta de las dudas que quizás se sienta y estamos comprometidos con ayudar a los delegados tan pronto como lleguen. Hay muchísimos beneficios al asistir a La Cima. Los estudiantes salen del campamento con un sentido de confianza en cuanto a sus habilidades para tener éxito en todas las áreas de su vida. De hecho, muchos estudiantes experimentan un aumento en su auto-estima, la honestidad, lo que esperan de su futuro y la habilidad de decir que no en las situaciones negativas.
Como padres, sabemos que es difícil confiar en que una organización pueda cuidar a su hijo/a. Nuestra meta principal es crear un lugar seguro donde los estudiantes puedan tener una experiencia de desarrollo personal y social. Como personal damos mucha importancia a la seguridad y supervisión del estudiante. Por eso tenemos unos sistemas para asegurar que los estudiantes estén bien cuidados. Un consejero y médico estarán disponibles 24 horas al día. Los estudiantes serán supervisados por maestros, facilitadores y consejeros de todas partes del estado. Los estudiantes serán separados por género en los dormitorios. Nuestro horario es intencional y ocupado. El Pico de Cispus y el programa de liderazgo operan bajo los Directores de Escuela de Washington, una organización que ha sido dedicada a campamentos de liderazgo para estudiantes de la escuela secundaria por más de 60 años.
Al empacar para el día de campamento por favor siéntase libre de traer instrumentos musicales, trabajo y herramientas de arte, y cualquier otro artículo que usted quiera compartir con otros delegados. Su lista de empaque debe incluir también un cepillo de dientes, pasta dentífrica, saco de dormir o sábanas y mantas, una almohada, una toalla, jabón/champú, zapatos cómodos, las sandalias, y ropa tanto para el frío y tiempo tibio. Favor de empacar la ropa que pueda ensuciar.
No hay servicio de teléfono celular ni "wifi" disponible en Cispus Learning Center. Si a los delegados les gustaría ser capaz de llamar a casa, necesitan traer una tarjeta de teléfono pre-pagado. El número de teléfono directo para el centro de aprendizaje es 360.497.7131. Los delegados podrán recibir correo en el campamento si se dirige al delegado, c/o La Cima Camp, 2142 Cispus Road, Randle, WA 98377.
La cosa más importante es subir al autobús. Cuando haya hecho esto todo lo demás ocurrirá. Si su escuela ha pedido nuestro servicio de autobús, Ud. recibirá los itinerarios del autobús con la hora de salida y locación aproximadamente 7 días antes del campamento. También un miembro de la familia puede llevarlo al campamento si es más fácil. No se permiten choferes estudiantiles. Si usted tiene cualquier preocupación por favor contácteme:
Vincent Perez Travis Ruhter Erika Ambrocio-Vasquez
318.510.1936 [email protected] 360.244.9601 [email protected] 509-881-5987 [email protected]
Bilingual Contact: Travis Ruhter 360.244.9601 [email protected]
Asociación de Lideres Estudiantiles de Washington teléfono: 360.497.5323 • FAX: 360.497.5324 • www.AWSLeaders.org
Campamento bilingüe de liderazgo de La Cima Patrocinado por la Asociación de los Directores de las escuelas de Washington