Junior Docent Profile - CSPM

Junior Docent Profile

Junior Docents and Parent(s)/Guardian(s) should work together to complete the profile. Please complete no later than Friday, May 11.

2024 Junior Docent Profile

ABOUT THE JUNIOR DOCENT

Junior Docent Preferred Name(Required)
Pronouns(Required)
If you would prefer that we do not contact the Junior Docent via their personal phone, please leave this blank.
Do you authorize text messages to this phone number?
If you would prefer that we do not contact the Junior Docent via their personal phone, please skip this.

EMERGENCY CONTACTS

Emergency Contact #1 Name(Required)
Emergency Contact #2 Name(Required)

TRANSPORTATION & AUTHORIZED PICK UP

Please verify how the Junior Docent will get to and from the Museum:(Required)
Select all that apply
Please list the (1) name (as it appears on their driver’s license), (2) relationship to the Junior Docent, and (3) phone number of each individual you authorize to pick up your Junior Docent. We cannot release students to anyone who is not on this list. If you need to make changes to this list, please submit an email with updates 48 hours prior to the next pick up.

HEALTH INFORMATION

Please list all medication that the Junior Docent is currently taking on a regular basis. Note that staff will not administer medications to Junior Docents. Junior Docents should plan to take all necessary medication before or after their shift. Junior Docents needing medication during a shift must speak with Meg Yevara at 719-385-5631 prior to the first day of the program to discuss a plan. Please note that over the counter medications (such as Ibuprofen or Tylenol) are not to be sent to the Museum. Museum Staff will not administer any medications. Families must provide any daily medications.
Junior Docents will be permitted to carry their Epi Pen and/or Inhaler with a Permission for Medication form signed by both the Junior Docent’s physician and parent indicating that they are capable/trained to administer their own medication. Junior Docents needing emergency medication during camp hours must speak with Meg Yevara at 719-385-5631 prior to the start of camp to discuss a plan. If parents do not provide an Epi Pen/ Inhaler Care Plan Museum staff will call 911 in the event of an emergency. If there is any deviation from the Care Plan (i.e., medication cannot be found) Museum staff will call 911 in the event of an emergency. In addition to the Permission for Medication form, Junior Docents who use an Epi Pen must have an Epi Pen Care Plan and Colorado Allergy and Anaphylaxis Emergency Care Plan on file with camp staff. In addition to the Permission for Medication form, Junior Docents who use an inhaler must have an Asthma Care Plan on file with Museum staff. Museum staff will not administer any medications. Families must provide any emergency medications.
You may also submit these forms via email to Meg.Yevara@coloradosprings.gov.
Drop files here or
Accepted file types: pdf, jpg, Max. file size: 32 MB.

    RELEASES AND WAIVERS

    These items must be reviewed and signed by an authorized parent/guardian.
    MARKETING
    FIELD TRIP TRANSPORTATION
    MUSEUM TRANSPORTATION
    MEDIA
    STIPEND
    In the event of any emergency, I authorize the City of Colorado Springs Recreation Services Program Staff to secure from any licensed hospital, physician, and/or medical personnel any treatment deemed necessary for my minor child/ward’s immediate care. I understand the Program Staff and the City of Colorado Springs are not responsible for paying for any services rendered by any medical professional or medical facility, or for the cost of transportation to or from any medical professional or medical facility and agree that I will be responsible for payment of any and all medical services rendered. I have read and fully understand the above Program Details, Waiver and Release of All Claims and Permission to Secure Treatment. I understand that this authorization is given in advance of any specific illness, accident, injury or medical emergency. This authorization is given pursuant to the provisions of the laws of the State of Colorado and shall remain in effect one year from the date this form is signed unless withdrawn or revoked prior to that date. Any withdrawal or revocation of this authorization shall be in writing and delivered to the Program Director.
    Please read this form carefully and be aware in registering your minor child/ward for participation in the City of Colorado Springs Recreation Services Program, you will be waiving and releasing all claims for injuries you or your minor child/ ward might sustain arising out of said program(s). I recognize and acknowledge that there are certain risks of physical injury to participants in a program, and I agree to assume the full risk of any injuries, damages or loss regardless of severity which I or my minor child/ward may sustain as a result of participating in any and all activities connected with or associated with such program. I agree to waive and relinquish all claims I or my child/ward may have as a result of participating in the program against the City of Colorado Springs Recreation Services Program and its officers, agents, servants and employees. I do hereby fully release and discharge the City of Colorado Springs Recreation Services Program and its officers, agents, servants, and employees from any and all claims from injuries, damage, or loss which I or my minor child/ward may have or which may accrue to me or my minor child/ward and arising out of, connected with, or in any way associated with the activities of the program. I further agree to indemnify and hold harmless and defend the City of Colorado Springs Recreation Services Program and its officers, agents, servants, and employees from any and all claims resulting from injuries, damages, and losses sustained by me or my minor child/ward arising out of, connected with, or in any way associated with the activities of the program.
    The undersigned (“Participant”), in attending Colorado Springs Parks, Recreation and Cultural Services (PRCS) programs and using the facilities and equipment associated with them, does so at Participant’s own risk. PRCS shall not be liable for any damages arising from personal injuries sustained by Participant while participating in PRCS programs or about the premises associated with the programs. Participant assumes full responsibility for any injuries or damages that may occur to Participant in or about the premises used in conjunction with the programs, and fully and forever releases and discharges the Colorado Springs Parks, Recreation and Cultural Services Department, the City of Colorado Springs and all associated employees and agents, from any and all claims, demands, damages, rights of action or causes of action, present or future, whether the same be known, anticipated or unanticipated, resulting from or arising out of the Participant’s use or intended use of the facilities and equipment associated with PRCS programs. Participant also acknowledges that programs are open to the public and that the City of Colorado Springs is not responsible for screening other Participants or members of the public for any infectious disease. Participant voluntarily assumes the risk of exposure to infectious diseases by attending City Facilities and understands that such exposure or infection may result in personal injury, illness, permanent disability, and death. Participant understands that the risk of becoming exposed to or infected any infectious disease may result from the actions, omissions, or negligence of Participant and others, including, but not limited to, City employees, volunteers, and program Participants and their families. Participant voluntarily agrees to assume all of the foregoing risks and accept sole responsibility for any injury to Participant including, but not limited to, personal injury, disability, death, illness, damage, loss, claim, liability, or expense, of any kind, that Participant may experience or incur in connection with Participant’s attendance at City Facilities or participation in City programming (“Claims”). Participant hereby releases, covenants not to sue, discharges, and holds harmless the City, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. Participant understands and agrees that this release includes any Claims based on the actions, omissions, or negligence of the City, its employees, agents, and representatives, whether before, during, or after Participant’s participation in any City program.
    Junior Docent Handbook