Background & Application The Anacostia Watershed Society’s Saturday Environmental Academy (SEA) offers FREE outdoor/environmental education fall and spring semester programs for 6th, 7th, and 8th graders. The fall program runs on Saturdays from late September – mid November and the spring program runs from mid March – mid May. Through this unique, fun, educational, multi-week (on Saturdays only) experience, students learn about their river and local environment, while developing skills in team building, critical thinking, and scientific investigation. Students from DC wards 5, 6, 7, & 8 and MD students within the Anacostia Watershed are strongly encouraged to apply. SEA will meet from 9:00 – 1:00 each Saturday of our semester programs. From our meeting location, in front of Chisholm Elementary School at 1001 G Street, SE, DC, we will venture out together for various environmental activities in our local environment. Activities increase environmental awareness and give students the opportunity to take positive action to improve their environment. Activities may include boating trips, cleanups, tree plantings, visits to community gardens and parks, etc. We ask that families only apply if they feel they can make a commitment to the program, barring unforeseen circumstances. Some exceptions to missing a session may be granted (e.g., school testing, illness, etc.). Go to anacostiaws.org or visit us on Facebook by clicking here to learn more about SEA. If you are interested in applying for a semester program for your child, please complete and submit the following form. If you have questions about the specific dates of a semester schedule or other, please contact Catherine Estes, SEA Program Director, at [email protected] or 202-368-1169. Meet new friends, build your resume for high school & college, and help the environment by joining SEA!Guidelines for Participation We have found that in order for the Anacostia Watershed Society’s Saturday Environmental Academy to be a positive and successful experience for all involved, some basic guidelines are necessary. Accordingly, each student is expected to: Commit to attending every Saturday session (barring unforeseen circumstances). Limited exceptions allowed. Catherine Estes, Program Director, must be notified in advance and can be reached at 202-368-1169 if a student is unable to attend a session. Arrive on time for each session (at 9:00 a.m. unless otherwise told), ready to participate fully. Pick-up is promptly at 1:00. Follow staff instructions, for the safety of self and others. Dress appropriately to be outdoors with the possibility of getting dirty and possibly wet. Closed-toe shoes and long pants are required for every session. Be respectful of oneself, others, and one’s environment. Expectations include keeping body parts to oneself, using positive language/communication, practicing “leave no trace” ethic in our meeting and outdoor environments, etc. Name-calling, hitting, use of inappropriate language, etc. is not permitted. Use of cell phones and any other electronic devices during the Saturday sessions is generally not permitted. Should a student need to bring a cell phone to make contact with parents/guardians at the end of a session then students must keep them stored away and turned off. If students use electronics without permission while SEA is in session, the electronics may be taken by staff and returned at the end of the session. If a parent/guardian must reach a student for an urgent matter during a session, they may call/text the SEA Program Director at 202-368-1169 (or another staff member as directed in weekly communications). Part of what makes SEA so valuable is that it gives students a space free of electronic devices, where they can engage fully with the group and nature. For the parents/guardians: All necessary forms must be received prior to a student participating in a session.Consent(Required) We (the Parent/Guardian and Student) have read the guidelines and agree to follow them.Date(Required) Month Day Year Student Information & Release FormStudent Name(Required) First Last Birth Date(Required) Month Day Year Grade(Required) 6 7 8 N/A – Student Leader Sex(Required) Male Female Non-binary Parent/Guardian (1) Name(Required) First Last Parent/Guardian (2) Name First Last Home Phone(Required)Work PhoneCell Phone(Required)Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code School(Required)Parent/Guardian Email (where SEA communications will be sent)(Required) Parent/Guardian Optional 2nd Email (where SEA communications will be sent) Health Insurance Carrier(Required)ID Number(Required)In case of emergency, notify:Name(Required) First Last Relationship to Student(Required)Phone Number(Required)In order for SEA staff to work effectively with our students, we like to learn about any areas that may be challenging for them. Please check the following area(s) in which your child has some difficulty. Check all that apply and explain below.(Required) Relating to other students Relating to adults Keeping temper under control Understanding and following directions Communicating effectively with others Other: Please explain any area(s) that you checked above:Is there anything about how your child learns that would be helpful for us to know in working with him/her? (For example, “My child has some difficulty with reading (or writing) and may need some assistance.” Or “My child learns best by….”)(Required)Note: A guardian may be asked to join the participating student in some cases where there are significant behavior challenges or special needs present.Parents/guardians — please read, complete, and consent to the following: I understand that participation in the Anacostia Watershed Society’s (AWS) Saturday Environmental Academy (SEA) is entirely voluntary. Participation may include, but is not limited to, multiple Saturday sessions. These sessions will include field trips and hands-on activities, such as trash cleanups, tree plantings, and boat rides. I understand that the events might involve light physical exertion – such as bending, lifting, and digging — and voluntary or involuntary contact with harmful plants and animals. I know and understand the risks involved in the above named activities, and I know and understand that unanticipated dangers might arise. I hereby release AWS from any responsibility for injury which might occur as a result of my child or my participation in AWS activities, except that AWS shall not be released from potential claims for the negligent acts of their agents, servants, employees, or volunteers acting on behalf of AWS. By consenting below, I give permission for my child/me to participate in AWS/SEA activities. I also give permission to authorize personnel to carry out such emergency diagnostic and therapeutic procedures as may be necessary for my child/me, and also permit such treatment procedures to be carried out by the local hospital(s) for my child/me in the event of any emergency. I further agree that my child’s/my photo, image, or likeness may be used for future Anacostia Watershed Society projects, such as video, online, documentary or print publication, and I hold said entities harmless in the use of my child’s/my photo or image. I also give permission for AWS and/or its representatives to send me messages about programs and activities sponsored by the organization and/or its partners at the email address supplied. I understand that AWS will never sell, or rent my personal information without my advanced consent. I also understand that I will always have the option to stop receiving email messages from AWS at any time and under any circumstances.Parent/Guardian Name(Required) First Last Consent(Required) I understand and consentDate(Required) Month Day Year Prompt pick-up of students at dismissal is expected. Please read the following statement and sign IF you grant permission: “My child has permission to wait outside of the SEA meeting place alone after dismissal if I am late and she/he/they may leave on their own from the SEA meeting place.”ConsentPlease only enter parent/guardian name here if permission, as described immediately above, is granted. I consent that my child has permission to wait outside of the SEA meeting place alone after dismissal if I am late and she/he/they may leave on their own from the SEA meeting place.To help us effectively recruit students, please tell us how learned about SEA: Listserv School Representative Friend/Colleague Website or Facebook Other Please elaborate on any area(s) that you checked above:Ex. DC Listserv, My friend (Otter Heron), a flyer at my local library, etc.Medical History Form*ALL ITEMS MUST BE FILLED OUT BY A PARENT/GUARDIAN. NO ONE WILL BE ALLOWED TO PARTICIPATE IN THE AWS’ SATURDAY ENVIRONMENTAL ACADEMY WITHOUT A COMPLETED FORM ON FILE.Student Name(Required) First Last Consent(Required) I consent that all items have been filled out by, me, a Parent/Guardian of the Student.General Questions (You MUST explain “yes” answers) Please answer “Yes” or “No” to the following 24 questions.Has/does the participant:1. Had any recent injury, illness or infectious disease?(Required) Yes No 1a. If you answered "yes" please explain:2. Have a chronic or recurring illness/condition?(Required) Yes No 2a. If you answered "yes" please explain:3. Take medication (prescribed or over the counter)?(Required) Yes No 3a. If you answered "yes" please explain:4. Ever been hospitalized?(Required) Yes No 4a. If you answered "yes" please explain:5. Ever had surgery?(Required) Yes No 5a. If you answered "yes" please explain:6. Have any emergency allergic reactions (e.g., bee stings, food, etc.)?(Required) Yes No 6a. If you answered "yes" please explain:7. Have frequent headaches?(Required) Yes No 7a. If you answered "yes" please explain:8. Ever had head injury?(Required) Yes No 8a. If you answered "yes" please explain:9. Ever been knocked unconscious?(Required) Yes No 9a. If you answered "yes" please explain:10. Ever had frequent ear infections?(Required) Yes No 10a. If you answered "yes" please explain:11. Ever passed out during or after exercise?(Required) Yes No 11a. If you answered "yes" please explain:12. Ever had seizures?(Required) Yes No 12a. If you answered "yes" please explain:13. Ever had chest pain during or after exercise?(Required) Yes No 13a. If you answered "yes" please explain:14. Ever had high blood pressure?(Required) Yes No 14a. If you answered "yes" please explain:15. Ever been diagnosed with a heart murmur, or other heart conditions?(Required) Yes No 15a. If you answered "yes" please explain:16. Ever had back problems?(Required) Yes No 16a. If you answered "yes" please explain:17. Ever had problems with joints (e.g., knees, ankles, etc.)?(Required) Yes No 17a. If you answered "yes" please explain:18. Have any skin problems (e.g., itching, rash, acne, etc.)?(Required) Yes No 18a. If you answered "yes" please explain:19. Have diabetes?(Required) Yes No 19a. If you answered "yes" please explain:20. Have asthma?(Required) Yes No 20a. If yes, does the child carry an inhaler?(Required) Yes No 20b. If you answered "yes" please explain:21. Had mononucleosis in the past 12 months?(Required) Yes No 21a. If you answered "yes" please explain:22. Had problems with diarrhea/constipation?(Required) Yes No 22a. If you answered "yes" please explain:23. If female, have an abnormal menstrual history?(Required) Yes No 23a. If you answered "yes" please explain:24. Have any dietary restrictions (e.g., seafood, pork, vegetarian, etc.)?(Required) Yes No 24a. If you answered "yes" please explain:During SEA’s Saturday sessions, I authorize an Anacostia Watershed Society staff member to administer the following over-the-counter medications or generic equivalent (i.e. for a headache, stomach ache, allergic reaction, etc.) to the participant. Please select all that you allow:(Required) Select All Tylenol Ibuprofen Pepto Bismal Anti-diarrhea Benadryl Cough drops Other If you selected "other" please explain below:Are there any specific activities to be encouraged, limited or avoided?(Required) Yes No If you answered "yes" please explain:Does the participant have a current tetanus shot?(Required) Yes No Date of shot Month Day Year Please provide any other important health related information about your child:Please read and consent to the following:Consent(Required) This health history provided in this document is correct as far as I know.Parent/Guardian Name(Required) First Last Date(Required) Month Day Year Contact Catherine Estes, SEA Program Director, at [email protected] if you have any questions.
