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About Siletz news letter. (Siletz, Oregon) 1989-1997 | View Entire Issue (Aug. 1, 1990)
SILETZ, OREGON August 1990 - PAGE 5 THE PEOPLE WHO SERVE YOU IN PORTLAND Kelly Strickler, Area Office Supervisor/Social Services Director Kelli Brugh, JTPA Director Irene Holland, CHN/Drug and Alcohol- counselor Connie Williams, Area Office Secretary » is d iiT p n in iß lQ x e Katy Holland« JTRACounselor s ? 8 ¡x o o c SILETZ TRIBAL HEAD START AUGUST 2 0 , 2 1 , 2 2 «1990» R O LLI JOM SUMMER ENCAMPMENT A P P L IC A TIO N Siletz Tribal Head Start Is a preschool program located In Siletz. Eligible children m ust be three or four years old on/betore September L U S Comprehensive services In education, social services, parent Involvement, health, nutrition, and transportation are provided. A p p lic a t io n s a r e a v a i l a b l e a t a n y CTS1 T r i b a l o f f ic e o r c a l l 4 4 4 - 2 5 3 2 . F e d e r a l In c o m e g u id e lin e s a p p l y : F A M I L Y S IZ E 2 3 4 5 IN C O M E $8,020 $10,060 $12,100 $14440 NOTE: lor each additional family member, add $2,040 T h is p rogram 1« op erated In accordance w ith U 5 . Departm ent of A g ricu ltu re policy, w h ich prohibit* discrim ination on the b a d * of race, color, sex, age, handicap, religion, o r national origin. A ny person w h o believe* he or she h a * been discrim inated against In a n y USDA a c tiv ity should w r ite to: A dm inistrator, Food A N utritio n Sendee, StOI P a rk C enter D rive, Alexandria, V irg in ia , 22302. STUDENT_________ _______________________ PARENT(S) SEND APPLICATION TO: C.T.S.I. JOM ENCAMPMENT P.O. Box 549 Siletz, OR 97380 ADDRESS__ GRADE____ AGE___ SCHOOL COUNTY IS DEADLINE FOR APPLICATION IS AUGUST 10, 1990. YOU CAN A LSO CALL IN APPLICATION INFORMATION TO WILLO DAUGHERTY, JOM CAMP COORDINATOR AT: 444-2532 (ext. 122) TOWN YOUR STUDENT TA K IN G ANY M E D IC A TIO N S ?; YES NO ' Hi L - S : ' ; / . ; IF YES, EXPLAIN _________ ■ ■ __» bOE8 YÔÜR 8TUDENT HAVE ANY M EDICAL OR D IS A B L IN G C O N D ITIO N S WE SHOULD KNOW' ABOUT? I F Y E S , E X P L A IN ____________________ 1 8 YOllR "STUDENT A LLERGIC TO A N YTH IN G , FOODS, C L O T H IN G , B T C . . . YES NO IF YES, EXPLAIN___________________ ___ CAM VOUR STUDENT SWIM? YES NO * 1 8 YOUR STUDENT SUBJECT TO CAR S IC K N E S ^ YES MO ; • X HAVE READ THE A B O V E J AND HAVE ANSWERED A t,L QUESTIONS TO THE J BEST OF MY KNOWLEDGE. MY SIGNATURE BELOW G IV E S CAMP COORDINATOR AND OR » ' LODGE COUNCELOR AUTH O R IZATIO N TO HAVE » M E D IC A L A TT E N T IO N I N CASE OF AN EMERG- » E N CY. » parent/quardlan LODGE COUNCELOR camp coordinator »
