Autorizason di Pais pa Paseiu pa Durmi Parental Authorization for Overnight Field Trip (Cape Verdean) Direson



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3. Nome da Medicação ________________________________________________________
Horário(s) para tomar ________________________________________________________
Motivo da medicação _______________________________________________________
Os efeitos colaterais estar ciente/outras informações _______________________________
4. Nome da Medicação ________________________________________________________
Horário(s) para tomar ________________________________________________________
Motivo da medicação ______________________________________________________
Os efeitos colaterais estar ciente/outras informações _______________________________
Informação Adicional /Instruções Especiais:

Eu autorizo o meu filho(a) a tomar os medicamentos acima mencionados nesta viagem.

_____________________________________________________ _________________

Assinatura do Estudante, se pelo menos tem 18 anos Data


________________________________________________________ _________________

Assinatura dos Pais/Responsável, se o aluno(a) for menor de 18 anos Data



Oggolaanshaha Waalidka ee Booqashada Habeen-dhaxa ah

Parental Authorization for Overnight Field Trip (Somali)
Tilmaamo:

Shaqaalah BPS: 1) Halkii booqasho hal foom isticmaal.

2) Buuxi qeybta foomka "School Portion" ee bogga 1.

3) Laba koobbi ka samee foomka halkii ardayba.

4) Hal koobbi u-dir guriga inay waalidka iyo ardaygu soo saxeexaan.

5) Xilliga booqashada, foomka orijinaalka ah ee saxeexan waa inuu sitaa hoggaamiyaha oo koobbina lagaga

tagaa xafiiska dugsiga.


Waalid/koriye sharci ah, haddii ardaygu ka yar yahay 18 sano, amase haddii uu ugu yaraan jiro 18 sano:

  1. Guud-mar oo akhriso "Parental Authorization and Acknowledgement of Risks” iyo “Medical Authorization” ee bogga 2.

  2. Buuxi qeybta "Medical Authorization" iyo “Medication Administration Form” ee bogga 3-5.


Ardayda: 1) Buuxi qeybta “Heshiis Arday”.

WAXA BUUXIN DOONO DUGSIGA

Magac Dugsi:

Magac Arday:


Taariikhda(aha) Booqashada:

Goob:


Ujeeddada:


Liiska Hawlaha:

Kormeerid: (Mid Calaamadee)

Ardayda waxa si toos ah booqashadan u-kormeeri doona waqti kasta hogaamiyayaal dad waaweyn ah.

Ardayda waxa si toos ah booqashadan u-kormeeri doona hogaamiyayaal dad waaweyn ah marka laga reebo

waxyaalahan:





Qaab Gaadiid: (Calaamadi dhammaan kuwa khuseeya.)

□ socod □ baska iskuulka □ Tareenka MBTA □ Qaab kale _______________


Aradydu waxay ka bixi doonaan: ___________________________________ xilli _________________.

(halkee) (waqti)
Ardaydu waxay ku soo noqon doonaan: _____________________________ abbaaro_____________.

(halkee) (waqti)
Hogaamiyayaalka mas'uulka ah:___________________________________________________________________
Heerka Hagaamiye/Arday: __________________________ (ugu badnaan 10:1)



WAXA BUUXIN DOONA ARDAYGA



HESHIIS ARDAY
Markaan ka-qeybgalayo booqashadan, waxaan fahamsanahay inaan noqon doono wakiil BPS iyo komuyuunatigeyga. Waxaan fahamsanahay in qiyamka haboon la raaci doono, iyo inaan oggolaan doono mas'uuliyadda ku dhaqanka dabeecad wanaagsan oo aan raaco xeerarka dugsiga iyo Xeerka Anshaxa ee Dugsiyada Dadweynaha Boston (BPS).
________________________________ __________________

Saxeexa Ardayga Taariikh

WAXA BUUXIN DOONA WAALIDKA/KORIYAHA AMASE ARDAYGA


OGGOLAANSHO IYO AQOONSI KHATARO

Waxaan fahamsanahay in ka-qeybgalka booqashadani tahay mid mutadawacnimo ah oo aniga/ilmaheyga ii keeni kara khatar. Waxaan akhriyey oo fahmay faahfaahinta booqashada (ee bogga 1 ee foomkan) oo waxaan oggolaaday in aniga/imahaygu ka qeybgalo waxyaalaha la-qorsheeyey ee booqashada.


Waxaan anigu qaatay mas'uuliyadda khatar shakhsiyeed amasemid ku timaadda waxyeello hanti oo ka timaadada amase la-xiriirta ka-qeybgalka imahayga ee booqashadan oo ay ka mid yihiin ficillo daayacaad ah amase waxyaale kale laga bilaaby il-biriqsiga ilmahaygu hoos tago kormeerka BPS illaa inta ay booqashadu socoto. Waxaan kaloon oggolahay inaanan u-qabsan Dugsiyada Dadweynaha Boston (BPS) iyo qof kasta iyo urur kasta oo kale oo la-xiriira BPS xagga hawshan inaan ku dacweeyo amase qaameeyo arrin la xiriirta ka-qeybgalka ilmahayga ee booqashadan.
Waxaan kaloo aan fahamsanahay in ka-qeybgalka booqashadu ay ku jiraan hawlo ka baxsan dhismaha dugsiga; sidaas darkeed, Dugsiyada Dadweynaha Boston iyo shaqaalaha iyo mutadawaciinta mas'uul kama ahaanayaan tayada iyo isticmaalka dhismaha aan ahayn kan dugsiga.
Waxaan fahamsanahay in BPS aanay mas'uul ka ahayn kormeerka aniga/ilmahayga xilliyada aniga/ilmagaygu ka maqan yahay hawsha la kormeerayo ee BPS. Xilliyadaas i waxay ku qoran yihiin qeybta "Kormeerka" ee bogga 1 ee heshiiskan.
Waxaan caddeynayaa in aniga/ilmahaygu akhriyey oo oggolaaday inay raacaan shuruudaha lagu sheegay Xeerka Anshaxa ee BPS, iyo inaan oggolaado dhammaan go'aannada ay sameeyaan macalimiinta, shaqaalaha, iyo kuwa awoodda leh. Waxaan oggolahay xaqa ay BPS u-leedahay inay fuliso xeerarka, qiyamyada, amarada. Waxaan oggolahay ka- qeybgalka aniga/ilmahayga ee booqashadan ay BPS joojin karto hadii aniga / ilmahaygu raaci waayo shuruudahaas, amase sabab kale oo ay BPS u-maleysay inay tahay danta kooxda ardayda ah, iyo in aniga/ilmahayga loo diri doono guriga aniga kharashka jeebkeyga oo aan lahayn soo-celin (refund). Intaas waxa dheer in hoggamiyayaashu ay beddeli karaan hawlaha si ay u-hubiyaan nabadgelyada qofka iyo/amase kooxda.
OGGOLAANSHO DAAWO

Waxaan caddeynayaa in aniga/ ilmahayga uu ku jiro xaalada jireed iyo mid maskaxeed oo fiican oo aniga/ilmahayga ma lihin xaalad gaara oo caafimaad amase jireed oo ka-hor-iman karta ka-qeybgalka booqashadan.


Waxaan oggolahay inaan dhammaan wada buuxiyo foomamka “Medical Information Form” iyo “Medication Administration Form” ee laga helayo bogga ugu dembeeya ee Oggolaanshahan.
Waxaan oggolahay inaan u-sheego BPS wixii daawooyin ah iyo/amase qoraallo daawooyin ay tahay in aniga/ilmahaygu qaato waqti kasta oo ka mid ah xilliga booqashada.
Haddii uu dhaco xannuun aad u xun amase dhaawac ilmahayga/korsadaheyga, waxaan oggolagay sida ku cad saxeexayga hoose in la siiyo kaalmo caafimaad oo degdeg ah, haddii ay sidaas ku taliyaan shaqaalaha caafimaadka ee fiirinaya ilmahayga. Waxa intaas dheer, inaan awood u-siinayo hoggaamiyaasha kor ku qoran inay wakiil ahaan aniga i-matalaan waalid/koriye ahaan xilliga uu ka-qeybgalayo booqashada kor lagu xusay taas oo ay ku jiraan gelinta iyo ka-saaridda ilmaheyga ee xarun caafimaad oo degdeg ah.
Haddii codsaduhu ugu yaraan jiro 18 sano, weerta soo socota waa inuu akhriyo oo uu saxeexo ardaygau:

Waxaan caddeynayaa inaan ugu yaraan jiro 18 sano, iyo inaan akhriyey oo aan fahmay Heshiiska kor ku qoran, oo aan oggolaaday oo la igula xisaabtimo doono qodobadan iyo shuruudahan.


_____________________

Saxeex Arday Taariikh


Haddi codsaduhu ka yar yahay 18 sano, weerta soo socota waa inuu akhriyo oo uu saxeexo ardayga waalidkiisa amase koriyihiisa sharciga ah:

Waxaan caddeynayaa inaan ahay waalid iyo koriye sharci ah, iyo inaan akhriyey oo aan fahmay Heshiiska kor ku qoran, oo aan oggolaaday oo la igula xisaabtimo doono qodobadan iyo shuruudahan aniga xaggeyga iyo anoo matalaya ardayga.


Waxaan fasaxayaa in: _______________________________________ uu ka-qeybgalo dhammaan hawlaha booqashada dibadda.

(Arday)
_____________________



Saxeex Waalid amase Koriye Taariikh
Ardaygu, haddii uu ugu yaraan jiro 18 sano, waalidka/koriyaha sharciga ah waa inuu buuxshaa macluumaadka hoos ku yaalla:
Daabac Magaca Koowaad iyo Kan Dembe: ___________________________________________________________
Cinwaan: ______________________________________________________________________________________
Teleefan: (Gacanta) ____________________ (Guri) _____________________ (Shaqo) _______________________
Magaca Koowaad iyo Kan Dembe ee Xiriirka "Emergency"ga: _____________________________________________
Waxa uu u-yahay Ardayga: ________________________________________________________________________
Taleefan Lambarada Xiriirka "Emergency"ga: __________________________________________________________



Foomka Macluumaadka Caafimaadka- Medical Form (Somali)

Magac Arday: Taariikh Dhalasho:

Magaca(yo) Waalid/ Koriye:


Taleefan: (Gacanta)______________ (Guri) ___________________ (Shaqo)________

Taleefan: (Gacanta)______________ (Guri) ___________________ (Shaqo)________


Macluumaadka Qofka lala xiriiri karo xilliga degdega ah: (ee aan ahayn waalid/koriye)
(1) ________ _______

Magac Ehelnimada Ardayga


___________ ______

Taleefan Lambar Macluumaad kale ee qofka

(2) ________ _______

Magac Ehelnimada Ardayga


___________ ______

Taleefan Lambar Macluumaad kale ee qofka



Magaca Dhakhtarkiisa Koowaad iyo Macluumaadkiisa (haddii arrin degdeg ahi dhacdo):

Magaca Bixiyaha Caymiska Caafimaadka, Lambarka Xeerka, iyo Macluumaadka Xiriirka ealth (haddii arrin degdeg ahi dhacdo):

Macluumaad Amarada Doonashada Caymiska (haddii arrin degdeg ahi dhacdo):

Ardaygu wuxuu leeyahay arrimaha caafimaad ee soo socda iyo/ama alarji oo ay tahay inay oggaadaan Dugsiyada Dadweynaha Boston - BPS:


Arrimaha Caafimaad:
Alerjiyo (cunto, caafimaad, cayayaan, dhir, xayawaan, iwm.):
Ardaygu wuxuu qaataa dawooyinka soo socda iyo/ama qoraallo dhakhtar oo ay tahay inay oggaadaan Dugsiyada Dadweynaha Boston - BPS:

Liiska/isticmaalka daawooyinka:

Haddii dawooyinka la qaato marka loo baahdo, sheeg calaamadaha ama xaaladaha lagu qaadanayo daawada iyo waqtiga ay tahay in mar kale la siin karo.

Ma waxa jira xaalad ka dhigeysa in ilmahaagu qaato barnaamij xaddidan oo jimicsi ah? (sida asmada, qalliin cusub, xaalad wadne, acabsi aan caadi ahayn, iwm.)


Haddii ay tahay haa, sheeg siyaabaha aad u-rabtid in loo xaddido barnaamijka:

Macluumaad dheeraad ah oo la xiriira caafimaadka ardayga oo ay tahay inay oggaadaan Dugsiyada Dadweynaha Boston - BPS:
Waxaan amrayaa sii-deynta macluumaadka kor lagu bixiyey shaqaalaha dugsiyada kale si ay isu-duwaan adeegyada.

________________________________________________ ____________________

Saxeexa Ardayga, haddii uu jiro ugu yaraan 18 Taariikh


_________________________________________________ _________________

Saxeexa Waalid/Koriye, haddii uu jiro ugu yaraan 18 Taariikh

* Haddii loo baahdo, warqadda dhakhtarka ku dhaji foomkan.

* Haddii loo baahdo, nuqullada dhokomantiga tallaalka ku dhaji foomkan.



Foomka Daawo-siinta- Medical Administration Form (Somali)


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