Gulf Coast Teaching Family Services, Inc. В В В В AAA Competition Vendor Registration Form Complete the form and return it to: Latonia Harrison 515 S College Rd., Ste 100 Lafayette, LA 70503 Phone: (337) 269-1165 ext. 54 Fax: (337) 235-1961 Email: toniam@gctfs.org В В Business/ Organization Name: В Contact person(s): Address: Phone: Fax: Email: В Indicate any special requirements you have: Event instructions: There is no charge for vendor space. The deadline to submit your registration form is September 1, 2009. A table and two chairs will be provided for each vendor. We ask that each business/organization bring its own table cloth and two door prizes. An eight foot table will be provided. Please arrive to begin setting up no later than 7:30 a.m. Registration for competition participants begins at 7:30. We look forward to seeing you there! Gulf Coast Teaching Family Services, Inc. В В В В AAA Competition Participant Registration Form Complete the form and return it to: Latonia Harrison 515 S College Rd., Ste 100 Lafayette, LA 70503 Phone: (337) 269-1165 ext. 54 Fax: (337) 235-1961 Email: toniam@gctfs.org or Your organizational liaison: Organization Name: Contact Name: Phone: Email: Participant Information: Participant Name: Date of Birth: Team Name (if Applicable): Address: Phone: IВ certifyВ thatВ IВ amВ theВ parentВ orВ legalВ guardianВ ofВ theВ aboveВ namedВ participant;В thatВ IВ herebyВ giveВ myВ permissionВ forВ him/herВ toВ participateВ inВ theВ TripleВ вЂњAAAвЂќВ competition;В andВ thatВ IВ herebyВ fullyВ release,В dischargeВ andВ holdВ harmlessВ theВ LouisianaВ DepartmentВ ofВ HealthВ andВ Hospitals,В theВ UniversityВ ofВ LouisianaВ atВ Lafayette,В GulfВ CoastВ TeachingВ FamilyВ Services,В Inc.,В andВ anyВ ofВ theirВ officers,В directors,В employees,В agentsВ andВ staff,В fromВ allВ liability,В claims,В demands,В actionsВ andВ causesВ ofВ actionВ arisingВ outВ ofВ orВ relatedВ toВ anyВ loss,В personalВ injury,В illnessВ orВ propertyВ damageВ thatВ mayВ beВ sustainedВ byВ him/herВ asВ aВ resultВ of,В orВ inВ theВ courseВ of,В his/herВ participationВ inВ thisВ competition.В В Signature of legal guardian:_ ______________________________________ Event(s) you are participating in (circle all that apply): Academics: Arts: Athletics: Essay Debate Step Stone Design Teen LaCHIP Logo Design Ball Toss/Tug-of-War (Please indicate team name) Cheer/Dance (Please indicate team name) Event instructions: There is no charge to participate. Lunch will be provided. The deadline to submit your registration form is September 1st. Sign-in for competition participants will begin at 7:30 a.m. and end at 9:00 a.m. Competitions will begin at 9:00 a.m. We look forward to seeing you there! Each category has its own instruction sheet attached. Gulf Coast Teaching Family Services, Inc. В В В В В В В В В AAA Competition Academics Instructions Essay: Write a narrative essay describing the importance of health care coverage as it pertains to teens. The essay should be 1-2 pages, typed, double-spaced, have margins between one and one and a half inches, and set at a 12 point font (no cursive). The cover page should look as follows: Name School LaChip's "AAA" Competition Date Title Start of essay. В В Each subsequent page should contain the student's last name and page number in the upper right hand corner. For example: Student 2 Deadline to turn in essays is September 17, 2009!! Debate: Our debate will be a Lincoln-Douglas debate with the following resolution: Resolved: Teen healthcare issues (i.e. mental health, suicide rates, pregnancy) are being adequately addressed by the public and private insurance industry. The Affirmative Constructive speaker will be allowed 6 minutes, with a three minute crossexamination by the Negative. The Negative Constructive speaker will be allowed 7 minutes, with a 3 minute cross examination by the Affirmative. The Affirmative Rebuttal will be 4 minutes, the Negative, 6 minutes. The Affirmative Rejoinder will be 3 minutes. Gulf Coast Teaching Family Services, Inc. В В В В AAA Competition Arts instructions Design a LaCHIP step stone: The stone should be between 7вЂќ by 7вЂќ and 10вЂќ x 10вЂќ. If you would like to participate, but are uncertain of how to make a step stone, many crafts stores sell stone making kits. Directions for making a stone without a kit can also be found online. Be creative, you donвЂ™t have to restrict yourself to cement, you can use what you have on hand. Just be sure that there are no sharp edges or extensions that could cut someone. Design a LaCHIP logo for teens: The logo should be 7вЂќ by 7вЂќ on white paper in the media of the artistвЂ™s choice. Entries are due by September 17, 2009. Below is a brief description of the LaCHIP message. You may want to consider some of this in your design. The Message LaCHIP is accessible. No cost coverage is available for uninsured children whose parents earn less than 200% of the Federal Poverty Guidelines (currently $3,052 per month for a family of 3). Low cost coverage is available for uninsured children whose parents earn less than 250% of the Federal Poverty Guidelines (currently $3,815 for a family of 3). You can apply online at www.lachip.org, over the phone at 1-877-2LaCHIP, or in person at any of the 500 application centers, or 40 Parish Medicaid Offices. Paper applications are also available many places throughout the community. LaCHIP is quality health coverage. LaCHIP provides coverage for doctor visits for primary care as well as preventive and emergency care. Immunizations, prescription medications, hospitalization, home health care, dental care, vision care, hearing care, lab work and tests, speech and language therapy, physical and occupational therapy, psychological tests and therapy, and mental health clinic services are all covered. LaCHIP is cost-effective. LaCHIP provides managed care for its enrollees. (Assigns each child a primary care physician who can make sure the child is getting his or her immunizations timely, and can build a relationship with the child and family, in order to better understand the individual childвЂ™s needs.) Managed care helps reduce avoidable hospitalization.1 LaCHIP is caring. LaCHIPвЂ™s goal is to insure every eligible uninsured child in an effort to provide each child with a healthier life. A childвЂ™s health is the foundation on which the rest of his or her life is built. LaCHIP is necessary. According to the most recent available data, there are approximately 1,291,025 children in Louisiana. At least 77,200 are uninsured and eligible for LaCHIP. It is estimated that approximately 5,400 of them live in Lafayette and its surrounding parishes.2 Without access to insurance, it is less likely that children will receive the healthcare they need. A healthy child is better able to learn and grow into a healthy and productive adult. A healthy child also increases his or her parentsвЂ™ ability to be productive at work and home. In essence, healthy children can lead to healthier, happier lives for the children and their parents. LaCHIP is valuable. LaCHIP provides all of these services for little or no cost to the client. 1 2 Gadomski, Anne; Jenkins, Paul; Nichols, Melissa. вЂњImpact of Medicaid Primary Care Provider and Preventive Care on Pediatric Hospitalization,вЂќ Pediatrics 101.3, (March 1998): e1 вЂ“ 10. Louisiana Department of Health and Hospitals Annual Report 2003-2004 Gulf Coast Teaching Family Services, Inc. В В В В AAA Competition Athletics Instructions Free Throw Toss/Tug-of-War: Teams will be made up of 5 individuals. Please be sure to include your team name when you register. Each individual on the team will be given the opportunity to attempt 3 free throws. The team will receive 1 point per successful attempt. The five-person team will then compete with other five-person teams in a tug-of-war. The team will also receive 1 point for each war it wins. The team with the most points at the end of the day will win this portion of the competition. Cheer/Dance: The routine should not be less than 3 minutes, or more than 5 minutes in length. Timing of the routine will begin at first organized movement or sound of music, and end when the squad hits its final motion, or the final note of music. You will be responsible for bringing your own music on a C.D. A representative will be needed to run your music while your team is performing. The only props permitted are flags, signs, poms and megaphones. Routines will be scored based on synchronization, choreography, crowd appeal, and execution & difficulty. Below is a brief description of the LaCHIP message. You may want to consider some of this in your cheer or dance. The Message LaCHIP is accessible. No cost coverage is available for uninsured children whose parents earn less than 200% of the Federal Poverty Guidelines (currently $3,052 per month for a family of 3). Low cost coverage is available for uninsured children whose parents earn less than 250% of the Federal Poverty Guidelines (currently $3,815 for a family of 3). You can apply online at www.lachip.org, over the phone at 1-877-2LaCHIP, or in person at any of the 500 application centers, or 40 Parish Medicaid Offices. Paper applications are also available many places throughout the community. LaCHIP is quality health coverage. LaCHIP provides coverage for doctor visits for primary care as well as preventive and emergency care. Immunizations, prescription medications, hospitalization, home health care, dental care, vision care, hearing care, lab work and tests, speech and language therapy, physical and occupational therapy, psychological tests and therapy, and mental health clinic services are all covered. LaCHIP is cost-effective. LaCHIP provides managed care for its enrollees. (Assigns each child a primary care physician who can make sure the child is getting his or her immunizations timely, and can build a relationship with the child and family, in order to better understand the individual childвЂ™s needs.) Managed care helps reduce avoidable hospitalization.1 LaCHIP is caring. LaCHIPвЂ™s goal is to insure every eligible uninsured child in an effort to provide each child with a healthier life. A childвЂ™s health is the foundation on which the rest of his or her life is built. LaCHIP is necessary. According to the most recent available data, there are approximately 1,291,025 children in Louisiana. At least 77,200 are uninsured and eligible for LaCHIP. It is estimated that approximately 5,400 of them live in Lafayette and its surrounding parishes.2 Without access to insurance, it is less likely that children will receive the healthcare they need. A healthy child is better able to learn and grow into a healthy and productive adult. A healthy child also increases his or her parentsвЂ™ ability to be productive at work and home. In essence, healthy children can lead to healthier, happier lives for the children and their parents. LaCHIP is valuable. LaCHIP provides all of these services for little or no cost to the client. 1 2 Gadomski, Anne; Jenkins, Paul; Nichols, Melissa. вЂњImpact of Medicaid Primary Care Provider and Preventive Care on Pediatric Hospitalization,вЂќ Pediatrics 101.3, (March 1998): e1 вЂ“ 10. Louisiana Department of Health and Hospitals Annual Report 2003-2004