SL]FFIELD ACADEMY - Suffield Academy

SL]FFIELD ACADEMY
Suffield, Conneccicut 06078. (860) 668-7315 . Fax (860) 668-2966
Chades Cahn Itr
Headmaster
June 3,2011
Dea¡ Parents and Students,
Thanks for your part in making this an excellent academic year. Now, with exams behind
us, we are already preparing for the fall.
As we look ahead to the next academic year, we are sending materials now in order to
begin early planning. Please review and complete the forms, which are identified on the
enclosed list. I ask that you return these forms as soon as possible-but no later than July 15
-
to Kim Goodwin in my office. V/e will forward them to the appropriate people.
This is the first of several mailings that you will receive from the school in the coming
weeks. The schedule for the other mailings is as follows:
June
July
August
Academic Office
Academic program overview and course offerings
Summer reading brochure
Standardized testing brochure (10s and 11ú grade students)
Office of the Dean of Students
Calendar for opening of school
Parents' copy of the new Student and Parent Handbook
Statement of Commitment
Car Registration form (day students)
Selection of Fall Afternoon Activity
Office of the Dean of StudentsiAcademic Office
Housing assignments (for boarding students)
Academic Schedule
If you have any questions about developments on campus, please do not hesitate to
conlact me. In the meantime, I hope you have a wonderful summer.
Sincerely,
Enclosures

SUFFTELD ACADEMY
LIST OF ENCLOSURES
A great deal of information is enclosed for your review and we will be happy to answer any questions that you have.
It is important that you read this material carefully, fill out the appropriate forms, and return them to Kim Goodwin in the
Headmaster's Ofhce as soon as possible. The required forms are due by July L5 and are indicated on the list below
with an asterisk (*). The other enclosures are optional forms or informational material.
1. xDatabase Yeriflrcation Form. Please make any corrections in the information (address, phone and fax, e-mail,
nicknames, etc.) on the form so that lve may update our records, if necessary. We will use your nickname for
nametags and letter salutations.
2. A revised Academic Year Calendar is included so that you may make plans for the coming year. Please note arrival
dates and times for the opening of school. Students invited to retum early for varsity athletics will be contacted by
coaches. New international students will find a schedule enclosed for registration on Thursday, September 8.
Please note the dates of Suffield vacations so that you can make travel arrangements that do not interfere lvith the
official academic schedule. Because exams are scheduled up to the final hour of a term, students must plan their
travel accordingly. If a student cannot leave for home on the final day of a term or on any another vacation departure
day due to flight schedules, he/she must notify the Dean of Students Office so that accommodations and supervision
may be provided for that night.
MEDTCAL FORMS-The appropriate forms-as indicated below-must be completed eachyear and we must have them
on file in the Suffield Academy Health Center before the start of school in order for your child to take part in any segment
of our program. A student may not participate in any athletic events-including pre-seøson varsity sports or orientation
activities-until øll the required medicalforms øre onfiIe in the Heølth Center.
3. *Explanation of Health Center Policies and Acknowledgement of Suffïeld Academy Medical Philosophy.
Please review the financial policies relating to services at the Health Center. These include routine services,
provided by the nursing staff, which are covered by tuition. There is a charge, however, for services provided by
the school physician, for transportation to off campus medical appointments, and for medication, etc. Please revielv,
sign and return Suffield's medical philosophy and expectations related to annual physicals and prescription
medication storage.
4a. *Physical Examination Record for returning students. Please schedule a physical for your child and have the form
oR completed, signed by the physician, and returned by July 75. The physical must høve been done within one ie&r.
4b. *Physical Examination Record for new students. Please schedule a physical for your child and have the form
completed (with the Immunization History-form #4), signed by the physician and retumed by July 15.
The physical ntust høve been done within one lear.
5. *Immunization History for new studcnts. This form should bc givcn to thc physician lvith thc Physical Examination
Record (form #4b).
6. *Permission for Medical or Surgical Treatment for all students. Suffield Academy does not provide medical or
accident insurance for its students. (See #9 below.) Expenses incurred as a result of accident or illness are referred
directly to you or to your insurance carrier. Please be sure to also complete the section regarding insurance coverage,
located on the bottom of the form, so that we may more efficiently help to process any claims.
7. *Authorization for the Administration of Prescription Medicine by School Personnel (if applicable).Any
medication prescribed for a student must be reported to and dispensed by the Health Center. All conditions requiring
prescription medication must be monitored by a physician. Connecticut State statute requires a physician's or dentist's
written order and the parent's/guardian's authorization for a nurse to administer prescription medicine. Medications
must be in a pharmacy-prepared blister pack and labeled with the student's name, name of the drug, strength, dose,
frequency, physician's or dentist's name, and date of the original prescription. Each prescription requires an
individual form. Photocopies of this form are acceptable.
8. *Permission to Administer Influenza Vaccine. Each fall the Health Center offers flu shots to students. You must
sign and return the form indicating lvhether or not you wish your child to receive the vaccine. Please carefully read
the information on the back of the permission form for complete details about the vaccine. The immunity provided
by this vaccine lasts for approximately three months. Students who are allergic to eggs or chicken feathers are not
eligible to participate in this clinic.
Continued on reverse

9.
10.
11.
l2
*Student Health Insurance l{aiverÆnrollment. A// students are required to carry health insurance. The "Medical
Insurance for Suffield Academy Students" information sheet explains an insurance plan offered through the school
for those students who do not already have coverage. Please read the information, and then sign the
Waiver/Enrollment form indicating your insurance status. Details of the insurance plans available are included in the
enclosed brochure entitled "Student Injury and Sickness Insurance Plan."
*Student Debit Card Form. Student charges and purchases are made through the Academy's Debit Card System.
Please review the explanation of the system and the expenses categories, and then complete the form.
*Photo Permissions & Press Release Form. The Communications Office at Suffield Academy is responsible for
press releases about student achievement and overall marketing of the school. Please fill out this form to: 1) give the
school permission to use photographs of your child in school marketing initiatives, and 2) help make sure your child's
name appears in your local newspaper when he/she receives a special commendation.
Music Lesson Registration (optional). The Music Department is able to offer private instruction on campus in
either instrument or voice. Please revielv the terms of this option and return the form with your payment if you
would like to pursue this opportunity. The special deadline-for this form only-is September 10.
BOARDINGSTUDENTS ONLY
13.
14-
General Information for Boarding Students with (optional) Shipping Information. Students often ask for
suggestions to furnish their dorm rooms and select both necessary and optional possessions to bring to campus. The
list we include lvith this mailing should serve as a guide in deciding what to bring to campus. Also included is
information on phones, mailing trunks to campus, and banking services available in Suffield, Connecticut,
Laundry Service (optional). We offer a choice of two laundry, linen, and dry cleaning services to interested
boarding students. There are two providers that students may choose from: E & R laundry and Dry Cleaners, or
Julie's Laundromat and Cleaners. Information about the services is enclosed.
Your request for service should be mailed directly to E & R or Julie's in the envelope they have provided.
ALLNE\trSTUDENTS
1-5.
Dress Code Guidelines. Dress code goes into effect after orientation on the first day of classes-September 12.
We have included the guidelines from the 2010-201! Student & Parent Handbook for your advance planning. You
will receive the20ll-2012 Handbook in midsummer.
NEW INTERNATIONAL STUDENTS ONLY
flncludes ¿ll students who reside outside of the US.-including US. citizens-as well as all non-US. citizens who reside in the US.)
16. Orientation for Nelv International Students. Details of arrival and registration for new international students are
given in this memo. Please note that orientation for new international students begins onThursday, September 8.
Required forms are due July 15,2011
Please return all Suffield forms to the Headmaster's Office to the attention of:
Kim Goodwin
Suffield Academy
185 North Main Street
Suffield, CT 06078
Phone: 860-668-7315 Fax: 860-668-2966 Email: kgoodwin@suffieldacademy.org
Mrs. Goodwin will distribute the forms to the appropriate offices.
s/3utl

Surrrnr,n Acennvry
aOII-20I2 ACADEMIC CALENDAR
Important Dates for Students and Parents
September
Tuesday 6 Varsity Candidates Registration (by invitation) -
Thursday 8 New International Students Registration -
Thursday 8 Remaining Seniors Registration - 9:30-1 1:00 e.u.
Friday 9 Remaining Grades 9, 10, 11 Students Registration -
Monday 12 Convocation;classes begin
October
Friday-Saturday 28-29
November
Fall Parents' Weekend
Saturday 29 Extended Weekend begins - 5:00 p.rvr.
Tuesday 1 Extended Weekend ends -
Wednesday 2 Classes resume
Monday-Friday 14-18 Fall Term Examinations
Friday 18 Thanksgiving Recess begins -
Monday 28 Thanksgiving Recess ends -
Tuesday 29 Classes resume
7:30 p.tr¿.
12 NooN
7:30 p.ir¡.
December
Thursday 15 Winter Vacation begins - 12:05 p.tr¿.
January
Monday 2 Winter Vacation ends - 7:30 p.vt.
February
Tuesday 3 Classes resume
Thursday 2 Extended Weekend begins -
Monday 6 Extended Weekend ends -
Tuesday 7 Classes resume
12:05 p.tvl.
7:30 p.tu.
March
Friday 2 Spring Vacation begins - 12:05 p.tr¡.
10:00 e.u.-12:00
9:30-11:00 e.u.
1:00-3:30 p.tr¿.
April
May
Sunday 25 Spring Vacation ends - 7:30 p.vr.
Monday 26 Classes resume
Friday-Saturday l3-I4
Saturday 14 Extended Weekend begins - 5:00 p.vt.
Monday 16 Extended Weekend ends - 7:30 p.rr¿.
Tuesday 17 Classes Resume
Spring Parents' 'Weekend (Parents' Association Auction on Friday)
Thursday 24 Reception for Seniors and Parents followed by Dinner - 5:15 p.ir,t.
Thursday 24 Baccalaureate - 8:00
Friday 25 p.tvt.
179th Commencement - 10:30 e.v.
Sunday-Thursday 27- 3I Spring Term Examinations for Grades 9-11
Thursday 31 Close of School for Grades 9-ll - 12 NooN 2t1t1t

SUFFIELD Ac¿.nnn,ry
Suffeld,CT 06078
HEALTH CENTER POLICIES
Most of the routine services of the Health Center are covered by tuition. Our professional nurses evaluate
students for common maladies; over-the-counter medications are provided for students with headaches, colds,
minor injuries and illnesses; ace bandages, crutches, ice packs, splints and other similar supplies are also
provided free-of-charge.
Our medical director, Dr. Ross Porter, Board Certified in Pediatrics, comes to campus on Friday mornings and
sees students who are ill or who need physicals, allergy injections, etc, The services of Dr. Porter and his
associates are not covered by tuition. Please check with your insurance company to verify whether visits to see
Dr. Porter will be covered. If a referral is needed from your child's primary doctor to see Dr. Porter or another
medical professional, please indicate this on the permission to treat form. The office of the medical
professional your child visits will submit claims to your insurance company, but the ultimate responsibility for
any bills incurred from medical professionals while your child is at school is yours. If bills remain outstanding
for long periods of time, the Suffield Academy Business Office will deduct payment from your child's debit
card account.
Prescription medications are obtained from Discover RX Pharmacy in Plainville, Connecticut, or CVS
Pharmacy in Suffield. The pharmacy is given your insurance information and will bill the insurance company
directly. Co-payments or full reimbursement for services will be billed to the family directly or deducted from
your child's debit account.
The Health Center coordinates transportation, which is provided by hired drivers, for medical appointments
scheduled off-campus. The cost for this transportation is $20 per hour and will be deducted from the student's
debit card account. There will be a charge of $20 if a student does not show up to meet the driver at the
scheduled time, unless the student notifies the Health Center at least two hours in advance.
Flu vaccinations will be provided to your student if you desire. The cost of the vaccination is $25 and may be
deducted from the student's debit card account, Once the flu vaccinations have been ordered, payment is
required.
All narcotic and mood-altering prescription medications are kept in the Health Center and must be supplied in
a blister pack from your pharmacy or from Discover RX Pharmacy. All medication must be in the original
container from the pharmacy and labeled. Prescriptions that are self-administered must be accompanied by
written instructions as to strength, dose and duration by the student's physician. Prescriptions for controlled
substance drugs and psychotropics must be kept at the Health Center and must be accompanied by the
physician's statement for administration.
On the other side of this letter is a form we require families to sign and return. It outlines school expectations
regarding annual physical examinations and the storage of prescription medication on campus. If you have
questions regarding our financial or health care policies, please call Donna Rabbett, Director of Nursing, at
860-386-4503.
5.31.11

FORM rs DunnvJur.v L5,201.1
SUf'ffnf,l AC,mBVfy
Suffi eld, Connecticut 0 60 7 I
ACKNOWLEDGEMENT OF SUFFIELD ACADEMY MEDICAL PHILOSOPHY
Student name:
All Suffield students, both returning and new, must have an annual physical. A physical
completed after March 1 of this year is acceptable for the upcoming school year. The
completed form must be returned by the physician to the Health Center by July 15.If, for
insurance constraints, you are unable to have a physical completed and returned by July
15, please notify the Health Center with the date of the physical. Should this date fall
after the start of school, a note from the student's primary care provider must be
submitted to the Health Center stating that your daughter or son is cleared to participate
in all school and athletic activities until the time of the physical. No student will be
allowed to participate in the above without a physical or note.
Prescriptions that are self-administered must be accompanied by written directions as to
strength, dose, and duration by the student's physician. Prescriptions for controlled
substance drugs must be kept at the Health Center. All prescription medication kept on
campus must be checked in through the Health Center. Medications that are to be
kept in the dormitory will be noted in the medical record, and the Health Center will affix
a label to the bottle identifying that this is safe to keep in the dorm and is documented.
Medication not checked-in is considered contraband, and the matter will be transferred to
the Dean of Students' Office. A few medications (controlled and many psychotropics) are
required to be kept in the Health Center and dispensed by the Health Center staff. All
medications must be brought to the Health Center within 24 hours upon arrival or return
to school.
Any required immunizations that are not complete may be administered at the Health
Center.
Please sign below to acknowledge you understand Suffield's medical philosophy and that
you have completed all the medical forms to the best of your knowledge.
Parent signature
Date
Student Signature
Date
5t3UIt

FORM rs DUD BY JULY 15,2011
Sunnrnr,o ACADEMY
Suffi e ld, C onnec ticut 0607 I
PHYSICAL EXAMINATION RECORD FOR RE?UÀN/NG STUDENTS
Please be complete. Omission of known health problems can jeopardize a student's health care and wellbeing.
A physical examination must be filed each year beþre a student møy participate in any part of the school program.
Physical must be done within one year.
STUDENT'S FULL NAME:
Date of Birth:
Blood pressure
Height
\{eight
inches
pounds
Pulse
Asthma (preventative & emergency treatment)
Allergies (pleaselist)
Immunizations since last physical:
Current medicaVpsychological conditions:
Psychotherapy or counseling history:
Review of Systems? Describe fully. Use additional sheet
if needed.
Medications to be continued at school: Please list
dose and schedule for each medication)
ABNL
My exøminationlinds the student named øbove to be in good heølth,free from
for øfull progrøm of study ønd sports.
contøgion, and physically und emotionelly quaffied
Yes No If no, please explain:
Print or type name and address of examining physicfun:
Phone number
City
Søte
zip
Physician's Signøture (Regu,itc!Ð
Date of Bxam

FoRM rs DUE By JuLy 15, 201 1
SUITIELD ACADEMY
Suffield, C onnect icut 0607 8
PERMISSION FOR MEDICAL OR SURGICAL TREATMENT
Treatment Waiver
This Jorn musl be signed by the student's parent or legal guardian so that appropriate diagnosß and treelment mny be promptly adminislered and so thal no
unnecessary delnys will occur in case oJ a medical or surgical enlergency. In the event of an emergency, every atternpl will be made lo contact and fully inform llte
parenls or legal guardian.
I hereby authorize the physician (M.D.) of Suffield Academy, Suffield, Connecticut, to procure and adminisler qnj care, medical or surgical, and an1, hospi¡o¡ çar.
deemed necessary to reslore lrcallh to my son or rlaughter.
M¡ son or dnughter has my permission to selJ-administer any medication, ordered by the school physician or consulting physician, with the approval of the school
nurse. The Headmsster or his designee nwy give permßsion for surgical or medical lrealment Íor my son or daughter in the event l/we cannol be conlacted.
I authorize the school nurse or cuthoriTed faculty member 10 admin¡ster medicalions prescrìbed by the school physician or consulting physician. I further authorize lhet
medical inJormation be released to faculty and advisors on a need to know basis.
STUDENT'S FULL NÀME:
(Please Print)
Date of Birth
Middle
Student's Social Security Number
List Any Known Ä,llergies;
Student's Signalure (if 18 or older):
Parent or Guardian's Signature: (if student is under 18)
Relationship to Studen(
Signature
Signature
Date
Please lype or print all inJormnlion requested below
Parents'Contact
Information
Name
Street Address
City/Sâre/Zip
Cell Phone
Relationship to Student
Home Telephone
Business Telephone
E-mail
In case the PARENT named above cannot be reached, please contâct:
Name
Street Address
CitylSt*elZip
Relationship to Student
Home Telephone
Business Telephone
Medical Insurance Information
ls a referral needed:
Name of Insurance:
Address to mail claim form:
Name of Subscriber:
-
PCP: Name
Phone:
Insurance Company's Phone Number:
Subscriber's Date of Birth
Subscriber's Place of Employment
Insurance Identification Number
Subscriber's Social Security number:
DR:5.24.1I
XXXPLEASE PROVIDE AN ENLARGED COPY oF THE FR0NT AND BACK OF ALL INSURANCE CANNSXXX
Please do not staple forms

FoRM ¡s DUE BY JULY 15,2011
SUfT.IELD ACÁ,DEMY
SUT'FIELD, CONNECTICUT 06078
AUTHORIZATION FOR THE ADMINISTRATION OF PRESCRIPTION MEDICINE
BY SCHOOL PERSONNEL
Any medication prescribed for a student must be reported to the Health Center. This form must be completed
for all controlled substances, mood altering medications and any other medication to be dispensed by school personnel.
Connecticut State statute requires a physician's or dentist's written order and the parent's/guardian's authorization
for a nurse to administer prescription medicine.
Medications must be in pharmacy-prepared blister-pack containers and labeled with the student's name, name of the
drug, strength, dose, frequency, physician's or dentist's name and date of the original prescription. The physician's name
and order must be the same on the authorization form and prescription bottle.
All prescriptions may be included on this form. Photocopies of this form are acceptable.
PHYSICIAN'S OR DENTIST'S ORDER:
Name of student:
Diagnosis:
I have evaluated and examined the student on (date)
and plan to reassess the medication and
treatment plan on (date)
Drug: (name, dose, frequency and method of administration)
Medication shall be administered from: (date)
to: (date)
Relevant side effects to be observed, if any:
lf there are side effects, give plan for management:
Is this a controlled drug? Yes
Physician's/Dentist's Signature:
No If yes, DEA #
Date:
(Print or type) Name:
Address:
Phone:
Fax:
5-27.tI

FoRM rs DUE BY JULY 15,2011
Sunrrpr,o Aclunprv
Suffield, Connecticut 0607 I
Permission to Administer Influrenza Vaccine
Please sign and return this form,
indicating your instructions in the box below.
The cost of the vaccine is $25.00
I have read the information sheet on the reverse of this form and I hereby authorize the
Health Center staff to administer the influenza vaccine to:
Name of student
tr I authorize a $25.00 charge to my child's debit card account.
Signature of parent or guardian
Date
DP.:S.24.11

IMPORTANT INFORMATION ABOUT INFLIJENZA AND INFLTJENZA VACCINE
Please read this carefully!
What is Influenza ("Flu")?
Influenza (or "flu") is a viral infection of the nose,
throat, bronchial tubes and lungs that can make someone
of any age ill. Usually the flu occurs in the United States
from about November to April. If you get the flu, you
usually have fever, chills, cough and soreness and aching
in your back, arms and legs. Although most people are
ill for only a few days, some persons have a much more
serious illness and may need to go to the hospital. On
average, thousands of people die each year in the United
States from the flu or related complications.
Who Should Get Influenza Vaccine?
Because influenza is usually not life threatening in
healthy individuals and most people recover fully, health
officials emphasize the use of vaccine for persons who
are at increased risk of complications from this illness.
Persons who are at an increased risk of complications
who should receive the influenza vaccine include:
. children and adults with severe asthma, heart
disease, diabetes, cystic fibrosis, kidney disease or
anemia which has required regular visits to the
doctor or hospitalization
. children and adults who have a type of cancer or
immunological disorder that lowers the body's
normal resistance to infections
. children and teenagers on long-term treatment with
aspirin who, if they catch the flu, may be at risk of
getting Reye's syndrome (a childhood disease that
causes coma, liver damage and death)
. residents of institutions housing patients of any age
who have serious long-term health problems
In addition, any person wishing to reduce their
chances of getting the flu may choose to receive a flu
shot, including:
. students or other persons in schools and
colleges, if a flu outbreak would cause major
disruptions of school activities
. persons traveling to the tropics at any time of the
year or to countries to the south of the equator during
April-September
Influenza Vaccine
Only a single flu shot is needed each season for
persons 9 years of age and older, but children 8 years of
age or younger may need a second shot after a month.
Children less than 13 years old should be given only
vaccine that has been chemically treated during
manufacture (split virus) to reduce the chances of any
side effects. Split-virus vaccines can also be used by
adults.
Possible Side Effects from the Vaccine
Most people have no side effects from recent
influenza vaccines. Flu shots are given by injection,
usually into a muscle of the upper arm. This may cause
soreness for a day or two at the injection site and
occasionally may also cause a fever or achiness for one
or two days. Unlike the 1976 swine flu vaccine, recent
flu shots have not been clearly linked to the paralytic
illness Guillain-Barr syndrome (GBS). In 1990-91 there
may have been a small increase in GBS cases in
vaccinated persons 18 to 64 years of age, but not in those
under 18 or those over 65. This possible association with
GBS was not as convincing as with the swine flu
vaccine. Even if GBS was a true side effect, the very low
estimated risk of getting GBS is less than that of getting
severe influenza that would be prevented by the vaccine.
As is the case with most drugs or vaccines, there is a
possibility that allergic or more serious reaction, or even
death, could occur with the flu shot.
People who Should Check with a Doctor Before
Taking Influenza Yaccine
. Persons with an allergy to eggs that causes a
dangerous reaction if they eat eggs and those who
have had a serious reaction to previous influenza
vaccination should consult a physician before
receiving the vaccine.
. Anyone who has ever been paralyzed with
Guillain-Barr syndrome should seek advice from
their doctor about special risks that might exist in
their cases.
. Women who are or might be pregnant should
consult with their doctor.
. Persons who are ill and have a fever should ask
their doctor whether or not they should delay
vaccination until the fever and other temporary
symptoms have gone.
Questions
If you have any questions about influenza or
influenza vaccination, please call us at the Health Center
or call your child's doctor before signing this form.

SUFFIELD ACADEMY
Suffield, Connecticut 06078 . (860) 668-7315 . Fax (860) 668-2966
Medical Insurance for Suffield Academy Students
20tt-2012
Sufflreld Academy requires that alt enrolled students have insurance to cover emergency and
other medical services which may be needed while they are at school. Suffield Academy offers a twooption
insurance package through the Student Insurance Division of the Mega Insurance Companies. This
coverage is used by many independent schools, as well as colleges and universities. Plan I is designed for
students who do not have existing coverage; Plan II is available to supplement existing medical insurance
coverage, particularly network plans (HMO) based in the child's home area which may not cover expenses
incurred away from home. A brief description of the coverages may be found on the back of this sheet. Your
child will receive an identification card and full description of benefits if you enroll in the program for the
20Il-20I2 school year. Our Health Center coordinates the interaction between health care providers and the
insurance company.
The premium cost for Plan I is $1,640 and it covers the twelve-month period from August 15,201I,
through August 14,2012. The premium cost for Plan II is $660 for full-year coverage (August 15,20II,
through August I4,20I2) or $550 for a ten-month option (August 15,2011, through June 14, 2012).
Please return this form to Suffteld Academy a.s soon as possible.
If you have any questions, you may call the Business Office at860-668-7315, or e-mail
pbooth @ suffieldacademy.org.
If you already have medical insurance coverage that will cover your child's expenses while at Suffield
Academy, and you have provided written documentation of that coverage (attached a copy of your insurance
card to the Permission for Medical or Surgical Treatmentform), please check Box A, sign and return the
attached Waiver/Enrollment form. If you cannot provide such documentation, you will be required to purchase
Plan I coverage. In order to enroll your child in the insurance program at Suffield, please check Box B on the
attached Waiver/Enrollment form, select the appropriate plan, sign the form and return it with your check (in
U.S, dollars),

FoRM rs DUE JuLy ts,2ltl
SUfflnf,l AC¡¡nVfy
Sffield, Connecticut 0607 I
Student Health Insurance WaiverÆnrollment
Student's name:
Please choose either option A (Waiver) or B (Enrollment, indicating the appropriate premium) and sign
the form below:
tr A: WAIVER
If you have existing medical insurance coverage:
As parent (guardian),I certify that the student listed above has medical insurance which will cover
expenses incurred by illness or injury while attending Suffield Academy. I have provided a copy of the front and
back of the insurance card (attached it to the Permission for Medical or Surgical Treatment form), which will be
on file in the Suffield Academy Health Center. I decline enrollment in the optional Plan II coverage.
tr B: ENROLLMENT If you do not have existing medical insurance for your child,
you must enroll in Suffield Academy Insurance Plan I.
If you have network-based insurance, you may enroll in Plan II
to supplement your existing coverage.
Please enroll the above named student in the medical insurance program offered through Suffield
Academy. I have enclosed payment in U.S. Dollars for the premium cost of the selected Plan; I understand that
the coverage will begin August 15,2011, or when I pay the premium, whichever date is later.
tr Plan I (Primary Coverage): Premium cost $1f40 (for coverage through August 14,2012)
tr Plan II (Supplemental Coverage): Premium Cost $660 (for coverage through August 14,2012)
tr Plan II: Premium Cost $550 (for coverage only through Jwe 14,2012)
Signature
Date
Please return this form to Suffïeld Academy as soon as possible. Ifwe do not receive the form from you by July 15,2011, we
will automatically enroll you in Plan I and, after that enrollment, we will not be able to arrange a refund from the carrier,
Please do not staple forms
5.20.tl

The Suffield Academy Debit Card System
Srunrxr Dnsrr Accoulr INronvrarroN
20rL-20L2
All student charges and purchases other than tuition are made through the Suffield Academy Debit Card
System. The Suffield Academy Debit Card is similar to a standard bank ATM card. V/hile cash and checks are
universally accepted for purchases and school charges, credit cards (Visa and MasterCard) are accepted in the
Suffield Academy B ookstore.
The Suffield Academy Debit Card is the preferred medium of exchange for student purchases at the School.
Similar to an ATM card, purchases and withdrawals can only be made as long as there is a sufficient balance in the
account to cover the transaction. Each student is required to have a Suffield Academy Debit Card for school expenses
and to present it at the time of a transaction. The card also serves as the student's official photo ID card. There is a
charge of $25 to replace a lost Debit Card. Your child's Debit Card will be valid throughout his or her years at
Suffield Academy. The card is required for all student purchases and withdrawals.
Experience has shown that, with this system, students view the money in their account as their own and, for the
most part, they demonstrate greater fiscal responsibility throughout the year than with open-ended charge privileges.
This system will provide our students a valuable and realistic experience in handling money and will provide parents
and guardians greater control over their child's miscellaneous spending.
The reverse side of this page provides an explanation of each expense category for which the Debit Card may be
used. Spending limits can be placed on selected expense areas. We recommend weekly or monthly restrictions in the
Cash Bank and Snack Bar categories. Other categories involve purchases which are essential in nature or are small in
size; therefore, restrictions are generally not used. On a monthly basis throughout the year, you will receive an
itemized summary of the Debit Card activity. Be sure to complete the address portion of the Debit Card form so that
the monthly statements are sent to the correct party. If your child is having trouble managing expenditures, please let
us know and we can work with you to implement other controls and restrictions.
An initial deposit received before July 15, 2011, is required to activate your child's Debit Card account
by the beginning of the school year. Additional deposits may be made at any time throughout the year by sending
payments to the Business Office.
Please filI out and return the Debit Cørdform with your initinl deposit by July 15,2011.Your cooperøtion in
meeting this ileadline will greatly facilitate our ability to service your child)s needs in the opening days of school.
The financially responsible parent or guardian may ask questions about or make changes to the account by
phone, mail, fax or e-mail (e-mail preferred) to:
pdellabernarda @ suffieldacademy.org
Suffield Academy Business Office
185 North Main Street
Suffield, CT 06078
Phone: 860-386-4455
Fax:860-668-2966

EXPENSE C¡.InconIns
1. CASH BANK: periodic cash withdrawals for student spending money. There is a limit of $50 per day per
student. May be used to dispense a weekly allowance. Even if you do not want to use the regular allowance
feature, it is convenient to allow a small monthly cash limit in order to cover emergency cash needs. Cash Bank
allowance that is not drawn carries over and accumulates from week to week.
2. BooKsToRE: covers textbooks, school supplies, school clothing and logo memorabilia, phone cards, some
personal toiletries and some athletic items.
3. Sxlcr BAR: operated in the Student Union for the convenience of the students, it sells such items as soft
drinks, juices, bagels, sandwiches and ice cream.
4. ArrnruCS: required and optional athletic equipment sold through the athletic department; also covers
uniforms and equipment which are lost, destroyed or not returned at the end of a season.
5. STUDENT Acrrvtuns: includes the cost of transportation and entrance fees for trips and activities organized by
the School.
6. ACADEMIC: includes charges for testing (sAT, PSAT, AP) fees, tutoring, aft materials, and other academic needs.
7. HEALTH CnNtnn: includes charges for health services, such as immunizations, diagnostic testing, prescription
medications and transportation for medical visits to off-campus providers.
8. MATNTENANCE: covers charges for replacing lost dorm keys and repairs for damage.
9. EXTRAoRDINARY CasH: covers cash required for special expenses or in sums larger than the cash bank limit.
Authorization for the use of this category requires an advance telephone call or written (mail, fax or e-mail)
permission sent by you to the Bookstore (or Business Office) before funds will be released. Permission to release
funds will be accepted only from the student's legal guardians.
ESTIMATES AND RECOMMENDATIONS FoR SpBNuNc NEEDS AND LIMITS
. Annual costs for required school supplies range from $200 to $400. Books for the fall term will be ordered
on-line from one bookseller (www.mbsdirect.net).
. Graphing calculators for upper level math courses cost in the $150 range.
. School sweatshirts cost about $40, other shirts range from $12 to $30, hats cost about $15, outer wear can
cost up to $70, computer software and hardware purchases are done by a special order arrangement.
. Given the above three parameters of the Bookstore business, we suggest that you make an initial large
deposit for school year startup.
If there are insufficient funds in your student's Debit Account to cover a requested or required transaction, the
system will not allow the transaction to occur until additional funds are deposited into the account.

FORM rs DUE JULY l5,20ll
SUFFIELDACADEMY
DEBIT CARD FORM
S ffi eld, C onnect icu t 0607 I
Please detach this sheet and fill in all information, Mail the completed form and your deposit by
July 15,Z}II,in order to activate your child's Debit Card Account.
Student's Name
Class of
Spending Restrictions
Pleøse check the appropriate boxes:
Cash Bank tr Unrestricted Use (maximum $50 per day)
Athletics
Unrestricted
Student Activities Unrestricted
Academic
lJnrestricted
Health Center Unrestricted
Maintenance
Unrestricted
tr V/eekly Allowance Amount
(Note: Cash Bank allowance that is not drawn carries over and
accumulates from week to week.)
tr No Cash Withdrawal Allowed
Extraordinary Cash Restricted to parent/guardian confirmation for each request.
Bookstore tr Unrestricted Use
tr MonthlyLimit
Snack Bar
tr Only Cash/Check/Credit Card Purchases Allowed
tr Unrestricted Use
tr Weekly Limit
tr Only CashiCheck Purchases Allowed
Amount Enclosed
(checks payable to Suffield Academy)
Please provide address of person(s) responsible for Student Debit Card Account. Monthly Debit Card Account statements will be sent to this
address:
Name(s)
Phone
Street
E-mail
City State Zip Code
Country
I/we understand that the maintenance of a balance in this account is my/our responsibility and that Suffield Academy will not, without my/our
request, advance funds to cover a lransaction unless there is a sufficient balance in the account.
Signature(s):
Date:
5.20.11 Please do not staple forms

SUFFIELD ACEOEVTY
Photo & Press Release Form
20rL-20t2
I. Permission for Use of Name and Photographs
The Marketing and Communications Office at Suffield Academy is responsible for overall marketing of the
school, which includes press about Suffield students. Toward that end, names and photographs of Suffield
students are used on the school's website, in the Academy's alumni magazine, other school publications as
needed, in regional and national magazines and newspapers, and in other forms of media, such as social
media websites. In addition the school creates certain administrative publications that include student names,
addresses and parents' names.
As parent or legal guardian of
(Student's nme)
I give permission to
Suffield Academy to use the names, information and photographs of the aforementioned student for school
advertising, marketing initiatives, administrative publications and other similar purposes that are intended to
promote Suffield Academy,
Signature
Date
II. Press Release Information
Please list the complete name and address of all of your local newspapers so we may share the good news
about your child's honor roll achievements, athletic awards, and Commencement.
Name of student
Year of graduation
Newspaper Name
City
State/Country
Newspaper Name
City
State/Country
Newspaper Name
City
State/Country
Check here if you do not want your child's name released to local papers.
5.31.11

FORM DUE By SEPTEMBER 10,2011 (SpECrÁ,L DEADLTNE)
SUFFIELDACADEMY
PRIVATE MUSIC LESSON PROGRAM
20rr-20r2
The Music Department of Suffield Academy offers private lessons at all levels for voice as well as instruments.
Lessons are offered once each week and students are expected to practice regularly. A year-round commitment
is important for substantial growth.
In order to secure contracts with professional teachers, it is necessary for the Academy to commit
financially to them in advance of the start of lessons. The cost of a full year of lessons is $900.00 (24
lessons), payable in advance to Suffield Academy.
Students interested in scheduling private lessons should read the list of Student/Teacher Commitments below
and fill in and sign the statement at the bottom, returning it with a check by September 10.
STUDENT/TEACHER CouvrrrunNls
1 In the case of an unexcused absence from a lesson, the teacher will be paid and the lesson will not be
rescheduled. In the case of two unexcused absences, the student's parents and advisor will be notiflred
and the possibility of discontinuing lessons discussed. If the number of these absences continues to
four, parents and advisor will be notified again with the assumption that the student is not interested
in lessons. The teacher will be paid for the lessons missed, and any balance of payment returned.
2. In the case of an excused absence (i.e., sudden illness or emergency), the lesson will be rescheduled by the
teacher if documentation is presented (a note provided by the school nurse or doctor). If the student is not
able to come to school on the day of a lesson (due to illness), in addition to notifying the school, the teacher
and the Music Department office must be notified directþ and immediately.
It is the responsibility of the student to reschedule the lesson with the teacher. If proper notification does
not take place, the lesson will not be rescheduled.
3. If a student cannot make a lesson for some other personal or school-related reason, and notifies the teacher at
least24 hours in advance, every effort will be made to reschedule the lesson. If the teacher cannot be reached
directly, the Music Department must be notified at least 24 hours in advance.
Please arrange for private music lessons at Suffield Academy for:
Student's nøme (please print)
Instrument
Please find enclosed check (payable in U.S. dollars to Suffield Academy) for $900.00
I understand and agree with the policies regarding private lessons.
Parent's signature
Date
Student's signature
5.31.11
Please do not staple the forms

SUFFIELDACADEMY
GENERAL INFORMATION FOR BOARDING STUDENTS
20tt-2012
Dormitory Room
Each student is provided with a desk, desk chair, wastebasket, bed and mattress, dresser, closet area, and windolv
shades. Clothes hangers, desk lamps, and pillows are the responsibility of each student, as are curtains, if desired.
Phones
Suffield will provide boarding students with a live telephone jack and access to intra-campus calls, local calls,
E911 service, all incoming calls and voicemail. Any long distance calls must be placed using a prepaid calling
card (available in the Bookstore and elsewhere). Each student must provide his or her olvn telephone handset.
Please refer to the Student & Parent Handbook, which will be mailed midsummer, for information regarding our
policies on cell phone use on campus.
Re c omme nde d B e lo nging s
The following is a list of articles-other than personal clothing-that you may want to bring to school. (Complete
details on personal clothing appear in the Sndent & Parent Handbook but a copy of the current dress code
guidelines is enclosed in this mailing for new students.) If you plan to subscribe to the linen service, please
disregard items that are preceded by an asterisk. All items you bring should be clearly marked with your name.
Trunks
Boots
Raincoat, hat
Overcoat or parka
Flashlight
Desk lamp (no halogen lamps)
Power strips (no extension cords)
Toiletry articles
Laundry baglbasket
Mirror
Blankets (1 or 2) (not electric)
Pillow
Bedspread
Wash cloths
xBath towels
*Sheets (long twin size)
*Pillow cases
Music system
Small bookshelf
Please note: In order to comply with the State of Connecticut's fire code, the following equipment is NOT
allowed-halogen lights, hot plates, hot pots, portable heaters, electric blankets, and any other appliance
with an open coil. Televisions, microwave ovens, and refrigerators are also not allowed. (Each dormitory
is equipped with a television and microwave oven in a common area.) In addition, personal mattresses
must conform to specific fire regulations. Please contact us for further details, if necessary.
Trunks and other baggage can be shipped to Brervster Hall; Suffield Academy; Suffield, Connecticut; 06078.
These should be sent prepaid during the last two weeks of August. To avoid being mislaid, they should be
addressed to the student. We will store your possessions in Brewster Hall until you arrive but cannot assume
responsibility for their safety. Alternatively, rve have contracted with the UPS Store for in-room delivery of
personal possessions. Please contact them at (860)871-7499 for specific details.
Banking Services
Suffield Academy provides petty cash banking services as part of its Student Debit Card System. (See Student
Debit Card Form for details.) A full range of banking services, including ATM, is available at First National Bank
of Suffield, Webster Bank, Enfield Federal Savings Bank, or Rockville Bank-all located within rvalking distance
of campus.
s.20.11

The UPS Store
Shipping Back to School?
We Can Have Your Boxes Delivered
To Your Room
When You Arrive!!!
Contact us for details:
store2 I 95 @theupqstore. com
(860) 871-74ee
Please Plan Ahead - We must receive your boxes by
August 3L, 2011 in order to provide this service!!

The UPS Store
Students Name
Shipping From:
Street Address
Back to School Shipping
ln -Room Delívery
(Order Estimate)
School
City, State, Zip
Phone #
Email
Items to Ship:
Box Weight (lbs.)
t.
BoxDimensions(l xwxh)
Declared Value Insurance
2.
3.
4
5.
Important Reminder: Please pack your boxes to meot packaging guidelines for UPS
declared value coverage!
- A minimum of 2" of cushioning around all sides of the box.
- Box should be able to withstand a drop from 3 feet high
- No shifting or movement of items within the box.
- Fragile items should be bubble-wrapped and doubleboxed.
Please plan aheadt! We must receive yourboxesby 813112011 in order to provide In-Room
delivery service!
Please complete information above and fax or email to The UPS Store. We will respond
with the your pricing quote based upon weights and dimensions provided.
Phone# - (860) 871-7499
Fax# -(860)871-8186
Email: store2 I 9S@theupsstore.com
Price
Signature
Card #
Exp
Card Type
Billing Zip
Security Code

t3
4
I)ress Code Guidelines
As published in the 2010-2011 Student & Parent Handbook
Suffield Academy's dress code provides an essential element of a foundation for success. Students
who enroll at Suffield should do so with the expectation that they will be asked to abide by the letter and
the spirit of Suffield's dress code. The letter of the dress code is embodied in the guidelines below.
The intent of the dress code is to encourage appropriateness of dress for both boys and girls.
Students should keep themselves clean and neat, and clothing should be in good. One key element of
appropriateness is modesty in dress that is neither in bad taste nor distracting or revealing.
Note: Boys' and girls'formal dress applies to clothing worn during the class day (Monday through
Saturday) and within the academic buildings/quadrangle (south of Stiles Lane and west of Main Street).
Boyst Formal Dress
. A sport jacket with buttons (no zippers) and a formal lapel (not collar) must be \ryorn at all times
except during the month of September.
. A tucked-in dress shirt and tie, a non-zippered turtleneck shirlsweater, or mock turtleneck in
good repair
. Dress slacks, corduroys or chinos with hidden tailored pockets and no frayed bottoms
. Dress shoes and socks
Girls'Formal Dress
The girls' dress code consists of three options:
. A dress, which must extend at least to the knee. Dresses without sleeves must be accompanied
by a sweater; footwear must be either dress shoes or styled sandals.
. A dress skirt, which must extend at least to the knee, with a buttoned, collared woman's blouse
or woman's collared dress shirt; or turtleneck shirlsweater. Footwear must be either dress shoes
or styled sandals. Shoes that attach to the feet only between the toes are not permitted.
. Dress slacks, corduroys, or chinos with hidden tailored pockets and no frayed bottoms
accompanied by a woman's blouse or woman's dress shirt; or turtleneck shirlsweater.
Note: A collared blouse/collared dress shirt does not include rugby shirts, tank tops, short or long-sleeved
polo shirts, flannel shirts, or any shirt with writing. Furthermore, under no circumstances may flip-flops
of any type be worn.
Saturday Morning Dress Code
Students may choose between formal dress code and Suffield Spirit dress code from 8:00-11:15 A.M. on
Saturday momings, except when otherwise stipulated. Suffield Spirit Dress includes the followingvisible
Suffield regalia (athletic jersey or Suffield Academy clothing from the school's bookstore)
above the waist in conjunction with formal dress for boys and girls. The intent of this dress code option
is to encourage school spirit.
5.24.1r