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Microsoft word - forms combo 2013

Listed below are the Behavior Contract Form, Memory Book and Website Permission, Acceptable Use Policy Form, User Guidelines, and the Emergency and Medical Information Form for participation in Junior DECATS 2013. The general guidelines are provided below and have been condensed into one form for convenience. Please complete and print out ONLY the Emergency Contact and Medial Information Form (page 3). On the bottom of the form you will find a place to initial that you have read and understand all the forms. Please return this form with your tuition balance ($350) by TUESDAY, April 30 to: Thank you!! BEHAVIORAL CONTRACT (read and initial on page 3) As a Distinguished Scholar attending the Junior DECATS, I agree to abide by the following guidelines. I understand that if these rules are not followed, I will be dismissed from the program. I hereby agree to: follow all the rules of the Junior DECATS Program at St. Rita School; treat other people with respect and cooperate with faculty and other students at all times; clean up and not litter the building or grounds of St. Rita School; follow through on all my projects, using my time to the fullest. I completely understand that if I am disruptive to my class, my behavior will be considered unacceptable and I will be dismissed from Junior DECATS without refund to my parents. MEMORY BOOK AND WEBSITE PERMISSION (read and initial on page 3) I give permission for my child’s picture and the contact information listed above to be included in this year’s DECATS Memory Book. I understand that the Memory Book is distributed as a keepsake to each faculty member and attending student, and that it may be used for students to maintain contact with new friends from the program. Student pictures will also be reproduced in the Memory Book. I also understand that student pictures, videos and work may be posted to the web but names will not appear on any pictures. ACCEPTABLE USE POLICY FOR EQUIPMENT AND SERVICES (read and initial on page 3) DECATS students may be enrolled in classes that involve the use of technological and media equipment and services. The hardware, software, cameras, editing machines, production and broadcast equipment, and Internet access is a benefit that is offered by the host school for DECATS students. As visitors to the school, it is very important that DECATS students understand their responsibilities and limitations. The following guidelines MUST be followed at all times. Failure to follow these guidelines can result in loss of privileges; removal from the program, and/or other measures as deemed appropriate by DECATS personnel, school personnel, and other authorities. USER GUIDELINES (read and initial on page 3) All users are expected to respect the rights of others. Never read, delete, alter, copy or modify any Users should not access, keep or send anything that they would not show their parents or teachers. Users must not release their own or anyone else's personal information on the Internet including name, address, phone number, and photograph. Users are expected to take the utmost care of computer and network resources. Violations include, but are not limited to, vandalizing any equipment or software, altering or removing any hardware or software, changing printer or desktop settings, or uploading or creating computer viruses. If a user identifies a security problem on the network, the user must notify an administrator or teacher immediately. The security problem should not be shown to other users. Users may not download, copy or install any programs without the consent of the technology department. Users are expected to follow all copyright laws. They must not copy software, music, or multimedia. Users are expected to notify school officials immediately of anyone who is accessing inappropriate material, attempting to disable the filtering software, or using the Internet or the network in an inappropriate manner. Internet access is expected to be used to provide learning and teaching consistent with the educational goals of DECATS. Use of the SRCS network and/or Internet for financial, commercial, or political purposes is prohibited. Chat rooms, instant messaging, and external e-mail accounts are not to be used on campus. We understand the guidelines stated above, and agree to use the equipment and services appropriately. I also give my permission for my child to have supervised access to the Internet. EMERGENCY CONTACT and MEDICAL INFORMATION
DECATS 2013 Clinic
Responsible parties to be called if parents cannot be reached: 1. Name__________________Relation___________ph#_______________ 2. Name__________________Relation___________ph#_______________ Permission for Emergency Treatment in School Clinic Permission to Call Doctor if Parents or Responsible Parties cannot be reached IN AN EMERGENCY Permission for Emergency Care at ___________________________________ Hospital (please name hospital of your choice) Conditions Requiring SPECIAL CARE: Allergy___________________________________ *If you have listed a food or insect allergy for your child, please bring liquid Benadryl to the clinic with a completed parental permission form and a physician’s note giving permission for the administration of Benadryl at school as needed. Please list any ACCIDENTS/SERIOUS Asthma ___________________________________ Bone or Muscle_____________________________ Seizures__________________________________ Heart_____________________________________ Daily Medications___________________________ Medications sent to school____________________
(***requires special permission form***)
PARENT’S SIGNATURE_________________________________________________ (please sign and date)
My scholar and I have read and understand the following forms as described on pages 1 and 2. (Initial on the line and sign one more time) _______________________ _________ _________________________ ______________

Source: http://www.jrdecats.biz/wp-content/uploads/2012/04/Forms-Combo-2013-web.pdf

Microsoft word - thermography intake form.doc

Thermography Clinic Inc. BREAST HEALTH HISTORY Name: _________________________________________ Age: _____ Date of Birth: _______________________ Address: _______________________________ City: ______________________Postal Code _________________ Home Tel: ____________________ Work Tel: _____________________ E-mail ___________________________ Occupation: __________________________________

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台北醫學大學附設醫院暨萬芳醫院皮膚科核心教材 Topical anti-inflammatory agent 一、外用類固醇 (Topical corticosteroids) 二、非類固醇類消炎劑 (Topical immunomodulator): 需長期塗抺 steroid 者可考慮使用 Topical antibiotics Erythromycin Metronidazole Mupirocin (Pseudomonic Bacitracin nd lipid pyrophosphate Æ interfere with

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