Monroe County School District
Superintendent of Schools
Mark T. Porter
Master
File Number: 16-581
File ID: 16-581
Type: Agenda Item
Version: 1
Action By: School Board
Vendor:
File Created: 04/04/2017
Department:
Subject:
Title:
Status: Approval Review
Final Action:
Approval of Out of Country (Cuba) Travel for Key West High School Sailing
Club
Internal Notes:
Agenda Date: 04/11/2017
Sponsors:
Effective Date:
Attachments: KWHS Sailing Club Trip to Cuba Apr 11 2017,
KWHSSC forms #1, Cuba permission slip
Recommendation:
Enactment Number:
Expiration Date:
Entered by: [email protected]
Expiration Date:
Approval History
Version
Seq #
Action Date
Approver
Action
Due Date
1
1
1
4/5/2017
Suanne Lee
Approve
4/6/2017
2
4/6/2017
Wanda Menendez
Delegated
1
3
4/6/2017
Theron Simmons
Delegated
1
4
4/7/2017
Karen Hladik
Approve
4/10/2017
1
5
4/7/2017
Wanda Menendez
Approve
4/11/2017
1
6
4/7/2017
Ryan Abrams
Delegated
1
7
4/7/2017
James Drake
Approve
4/11/2017
History of Legislative File
Ver- Acting Body:
sion:
Monroe County School District
Date:
Action:
Sent To:
Page 1
Due Date:
Return
Date:
Result:
Printed on 4/7/2017
X
First and Last Name Printed: __________________________
Key West High School Sailing Club 2016-2017
Welcome to the
Key West High School Sailing Club
KWHSSC stands on the platform of having FUN, and sailing safe!
Description: It is the intention of KWHSSC to introduce students to sailing, both for pleasure and
competition.
KWHSSC will be meeting monthly on campus with a faculty sponsor, and weekly at the Key West
Community Sailing Center KWCSC located off Palm Ave in Garrison Bight. Students may also qualify
to attend sailing competitions at the Orange Bowl Regatta on Biscayne Bay in Miami in December 2016,
as representatives of KWHSSC. Students must maintain good grades and behavior in school in order to
attend competitions.
Membership and Equipment: KWHSSC is open to advanced, intermediate and beginning sailors and all
equipment and boats will be provided, free of charge (through community sponsors), by the KWCSC.
Anyone may join to learn how to sail whether they choose to compete or not, however yearly
competition is one of the KWHSSC goals. We aim to provide a place to learn sailing skills, along with
safe boating, and good sportsmanship while demonstrating respect, responsibility and reliability
towards; the ocean, other human beings, animals and property.
Safety: Like any other sport, safety is something taken very seriously and students must adhere to the
club practices and guidelines. All Florida and Federal boating laws must be followed. Sailing is a safe
sport when rules and common sense are instilled as expectations from the onset. KWHSSC will instruct
members with safety tips, techniques and rules for sailing, good seamanship, and good sportsmanship.
A safety commitment contract will be signed by all members. A notarized medical waiver, physical form
and liability forms will be kept on file for all members. Everyone is required to wear USCG approved life
jackets under way, which will be provided.
Student Benefits: Students learn the fundamentals of sailing, good seamanship, respect for the ocean
and weather, racing skills and the responsibility of being a good steward of our oceans and waterways,
as well as care for boats and equipment. Students benefit from learning to navigate safely on our
waterways and to be able to return safely back to port at the end of each day.
Short Term Individual Goals: Members will focus on the fundamentals of sailing and safe boating.
Students will maintain good grades and appropriate behavior, on and off the school and sailing club
campus, to retain eligibility in the KWHSSC.
Long Term Group Goals: The sailing season is year-round and prepares the sailor for a lifelong sport that
encourages a healthy and fit lifestyle.
First and Last Name Printed: __________________________
Key West High School Sailing Club 2016-2017
Sponsors: Capt. K. A. Braud, MEd, and Rebecca Provost will be the KWHS sponsors for the 2016-2017
school year, along with Bill Archer form the KWCSC, and meetings will be located in Rm: 2-206 at
KWHS. (times TBD)
[email protected] 305-293-1549 X54391, [email protected] X54434
CHECKLIST: KWHSSC members need the following:
Consent for Medical Treatment (2p) / parent sign and notary public sign
Safety Commitment Contract (1p) / student sign
KWCSC Liability Release Form/ parent/guardian sign, and student sign
MCSD Pride and Commitment Form (2pgs) / student sign and parents sign
Physical on file / attach a copy for Capt K. Braud
Copy of primary insurance for Capt K. Braud (school insurance required if student is not
covered by parent’s insurance)
1.
Attach a copy of your primary insurance here please. Thank you.
2. Attach a copy of your physical. Thanks.
If you have a physical on file this year, for another sport, and you did not retain a copy,
write the sport here and we will locate it: _______________________________
3. All forms, filled out, signed and notarized are DUE ONE OR BEFORE January 13, 2017. Turn
everything in to Capt. K. Braud in room 2-206.
Parent or Guardian, please sign below giving your student permission to participate in The Key
West High School Sailing Club; KWHSSC
Student Name: __________________________________
Parent/Guardian Name: ___________________________________
Date: _________
Parent/Guardian Signature: ______________________________________
First and Last Name Printed: __________________________
Key West High School Sailing Club 2016-2017
CONSENT FOR MEDICAL TREATMENT
First and Last Name Printed: __________________________
Key West High School Sailing Club 2016-2017
First and Last Name Printed: __________________________
Key West High School Sailing Club 2016-2017
Liability Release Form
FOR FIELD TRIPS / KWHSSC
Part1. Student Acknowledgement and Release
I voluntarily accept any and all responsibility for my own safety and welfare while participating in
KWHSSC
during 2016-17 school year, with full understanding of the risks involved. Should I be 18 years of age or older, or
should I be emancipated from my parent(s)/guardian(s), I hereby release and hold harmless The School Board of
Monroe County, Florida, and the Monroe County School District of any and all responsibility and liability for any
injury or claim resulting from such participation and agree to take no legal action against The School Board of
Monroe County, Florida, or the Monroe County School District because of any accident or mishap involving my
participation. I hereby authorize disclosure of my individually identifiable health information should treatment
for illness or injury become necessary. I have read this document carefully and know it contains a release. I also
acknowledge my right to revoke this release only by submitting a written revocation. By such revocation I
acknowledge I will no longer be permitted to engage in the activities referenced herein.
Part 2. Parental/Guardian Consent, Acknowledgement and Release
I, on behalf of my child participant or ward participant, do hereby release and forever discharge and agree to hold
harmless; The School Board of Monroe County, Florida, and the Monroe County School District while my child or
ward is participating in the above, and the directors and board members thereof from any and all liability, claims
or demands for personal injury, sickness or death, as well as property damages and expenses of any nature
whatsoever which may be incurred by the undersigned and/or the child/ward participant that occur while said is
participating in the above described activities. Including but not limited to, any negligence of the School Board of
Monroe County and the Monroe County School District.
Furthermore, I (on behalf of myself, my child/ward participant) hereby acknowledge and expressly assume all risk
of personal injury, sickness, death, damage and expense as a result of participation in activities involved therein.
The undersigned further hereby agrees to hold harmless and indemnify said organization(s), its directors,
employees and agents, for any liability sustained by said travel organizers as the result of negligent, willful or
intentional acts of said participant, including expenses incurred attendant thereto.
Additionally, I/we know of and acknowledge that my child/ward knows of, the risks involved in the above
activities understand that serious injury, and even death, is possible in such participation and choose to accept
any and all responsibility for his/her safety and welfare while participating in said activities. With full
understanding of the risks involved I/we release and hold harmless The School Board of Monroe County, Florida,
and the Monroe County School District of any and all responsibility and liability for any injury or claim resulting
from such participation and agree to take no legal action against The School Board of Monroe County, Florida, and
the Monroe County School District, because of any accident or mishap involving said participation as listed above,
of my child/ward. I authorized emergency medical treatment for my child/ward should the need arise for such
treatment while my child/ward is under the supervision of The School Board of Monroe County, Florida, and the
First and Last Name Printed: __________________________
Key West High School Sailing Club 2016-2017
Monroe County School District. I/we further hereby authorize the use or disclosure of my child’s/ward’s
individually identifiable health information should treatment for illness or injury become necessary.
I/we also acknowledge the right to revoke this release only by submitting a written revocation. By such
revocation I/we acknowledge my child/ward will no longer be permitted to engage in the activities referenced
herein.
I (we) are the parent(s) or legal guardian of this participant and hereby grant our (my) permission for him/her to
participate fully in said activity and hereby give our permission to take said participant to a doctor or hospital and
hereby authorize medical treatment, including but not limited to emergency surgery or medical treatment, and
assume the responsibility of all medical bills, if any.
Further, should it become necessary for the participant to return home due to medical reasons, disciplinary action
or otherwise, I (we) hereby assume all transportation costs.
Print name of participant
Father
Date
Signature
Mother
Date
Signature
Guardian
Date
Signature
Participant Only
I, __________________ (Name of Student) have read the above and understand the rules of conduct and will fully
abide by them, as well as all additional instructions of the leadership of this trip and activity directors. I have read this
carefully and acknowledge it contains a release, and agree to be bound by this document and its representations.
X
Student Signature
First and Last Name Printed: __________________________
Key West High School Sailing Club 2016-2017
SAFETY COMMITMENT CONTRACT
- I agree to wear a Coast Guard approved life vest at all times while underway.
- I agree to adhere to all federal and state boating laws and regulations and KWCSC rules
and procedures.
- I agree to always have situational awareness around me for other boats, people and
objects in the water.
- I agree to keep a proper distance between myself, my boat and other boaters, markers
and buoys.
- I agree to provide assistance to any boater who may be in peril or danger and to follow
the instructors directions at all times, even if I disagree with them.
- I agree to show courtesy and respect to others around me when launching and retrieving
a boat, competing, and throughout the time I am a member of
KWHSSC.
- I will always remember to avoid risk to myself and others, when sailing with
KWHSSC
and on my own.
- I will NOT ride under the influence of drugs or alcohol, or use tobacco of any kind when
sailing with
KWHSSC, or on my own.
- I agree to participate at my own risk.
I understand and will comply with the Safety Commitment Contract:
_______________________________________ /
_____
Student signature
date
“Student Success…
Whatever it takes”
MONROE COUNTY PUBLIC SCHOOLS
PRIDE & COMMITMENT CONTRACT
First and Last Name Printed: __________________________
Key West High School Sailing Club 2016-2017
Pride and Commitment Form
School: Key West High School
Activity: Key West High School Sailing Club 2016-2017 ;
School Year: 2016-17
KWHSSC
Students have the opportunity and privilege to participate in extracurricular
activities, including but not limited to athletics, band, chorus, cheerleading, performing
groups, clubs, and student government.
This Pride & Commitment Contract demonstrates each student’s becoming a
representative of the school. Failure to abide by these expectations, both on school
property and in the community, will result in the consequences listed in the Scope of
Consequences.
**Anonymous tips concerning student behavior will not be considered by the
administration.
Conduct Expectations
 I will set a personal example of excellent conduct.
 I will attend classes and follow the attendance rules of the school and District.
 I will dress appropriately, use proper language, display a positive attitude, be respectful
to teachers, administrators, and fellow students, and adhere to the District’s Code of
Student Conduct.
 I will follow the school rules and the specific rules and procedures of individual
coaches, directors or sponsors.
Community Role
 I will display a positive attitude, use proper language, and be respectful throughout the
community. I understand my actions represent the school, the principal, the staff, and
my fellow students.
 I will respect the personal property of others and will not physically or verbally harm
other individuals.
 I will follow the laws governing all citizens and residents of the United States, the State
of Florida, and Monroe County.


Personal Health
I will refrain from the use of alcohol, tobacco (including chewing tobacco), or drugs; nor
shall I be in possession of such substances during or away from school.
I will abide by the District’s Athletic Drug Testing Program, where applicable.
First and Last Name Printed: __________________________
Key West High School Sailing Club 2016-2017










Unacceptable Behaviors
Use or possession of drugs, including alcohol
Assault or battery (including both verbal or physical assault)
Violations against public health and safety
Possession of a weapon
Use of tobacco products
Disrespect to people or property
Refusing to comply with school administrative procedures
Violation of other school regulations which lead to in-school suspension, out of school
suspension or Saturday School
Unsportsmanlike conduct on and off the field
Missing a regatta or practice without prior approval.
Scope of Consequences
Appropriate sanctions shall be established by student leaders, subject to administrative
approval, and may include but not be limited to the following:





Referral to Coach for disciplinary consequences
Suspension from one or more practice, event, or competition
Completing a designated program with a Life Skills Counselor or School Drug Testing
as assigned
Probation
Removal from the team, program, or club
By signing this I am showing that I am committed to my school, to my
community, to my fellow students, and to my sport or organization. I am responsible for
my behavior, and I have pride in my personal conduct. I will be a role model and
ambassador of my school.
Name (printed):
Signature:
Date:
Student: _________________________
____________________________
______
Parent: _________________________
____________________________
______
First and Last Name Printed: __________________________
Key West High School Sailing Club 2016-2017
KWHSSC Sailor Information Sheet
Full Name: __________________________________________________
If this is your first year, who (if anyone) referred you? ___________________________________
Homeroom teacher’s name and room number: ________________________________________
What year are you in school? _______________
What is your shirt size?
Email address: _______________________________________
Your Cell #: ______________________________ May I text you? _______ May members text you? ____
T-shirt size: ___________________________________________
Parent’s names: ___________________________________________
Parent’s email: ____________________________________________
Parent’s phone: __________________________________________ may I text? ______
Why are you interested in Key West High School Sailing Club?
_____________________________________________________________________
Have you been in this club before? _______ If so, how many years? ______
Do you have hat and polarized sunglasses?
Yes/no
Do you have your own USCG approved lifejacket?
Yes/no
Do you have a Key West High School Sailing Club SHIRT?
Yes/no
Can you swim across a pool, without assistance or floatation devices?
What level sailor are you?
New/beginner/intermediate/advanced
Yes/no
Parents- For your child to participate in the activities
described below, your permission is required.
STUDENT NAME ___________________________________________________________________________
FIELD TRIP/ACTIVITY/DESTINATION:
PURPOSE:
Participate
DATE OF TRIP/ACTIVITY:
TIME OF DEPARTURE:
TIME OF RETURN:
KWHS Sailing Conch’s Trip to Cuba
in Hemingway Days 25th Anniversary sailing events
May 18 – 22, 2017
Morning on May 18, 2017
Afternoon/Evening of May 22, 2017
Bus/van RT to Ft Lauderdale airport, plane RT to Havana, Cuba,
Transportation throughout Cuba via private van.
TRANSPORTATION BY:
==========================================================================
I/we give permission for my/our child to participate in the
activity and/or event described above.
____________________________________
Parent(s) or Guardian(s)
MCSD-ADM003-02/27/2006
_____________________________
Date