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. yearbook@russiaschool.org 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 mfulk@russiaschool.org 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 mfulk@russiaschool.org 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