field trip authorization form · 2018-04-03 · title: microsoft word - 2018 field trip permission...

Office address: Harris House, 678 South Main Street, Geneva, NY 14456 Mailing address: 300 Pulteney Street, Geneva, NY 14456 Conferences and Events Office e-mail: events@hws.edu

Phone: 315-781-3103 Fax: 315-781-4325

Office of Conferences and Events

FIELDTRIPAUTHORIZATIONFORMFORMMUSTBECOMPLETEDANDSIGNEDBYAPARENT/GUARDIAN.

ConferencesandEventsOfficemustreceivecompletedformpriortofieldtrip.

PROGRAMNAME: KidsCollegeandKinderCampDESTINATION: CorningMuseumofGlass,121CenterWay,Corning,NY14830DATEOFTRIP: Friday,June29,2018DEPARTURETIMEFROMCAMPUS: 9:00AMANTICIPATEDTIMEOFRETURNTOCAMPUS: 4:15PMDIRECTOROFPROGRAM: PatriciaHarlingDIRECTOR’SPHONENUMBER: 315-521-5928

Permission I,theparent/guardianof______________________________________________________________,certifythat,tothebestofmyknowledge,mychildisingoodhealthandabletoparticipateinthisevent.

Accommodations Arethereanyaccommodationsneededfortheparticipant?Ifso,pleaseprovideinspacebelow.

Parent/guardianSignatureDate