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: [email protected]
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
