The Computer School
100 West 77th Street New York, NY 10024
Monday - Friday
9:00am - 3:20pm
DOE Parent Notification/Consent Form
Overnight/Extended Day Trip
|Name||HR:||Trip Dates: 10/10-10/11|
|Destination:||Frost Valley YMCA||Departure Site:||Computer School|
|School||The Computer School (MS245)||Departure Time:||8:30 am 10/10|
|Advisor(s):||Jessica Shalom||Return Site:||Computer School|
|Transportation:||Chartered Coach Bus||Return Time:||3approx. 3pm 10/11|
|Purpose of Trip: Team Building & Outdoor Education|
|Specific Activities Planned: Hiking, High ropes, Low Ropes, Team Building Activities|
I, the parent/guardian of the student named above, hereby give my permission for my child to take part in the school trip described above.
|a)||I am responsible for getting my child to and from the departure and return sites identified above. I understand that my child shall be accompanied by staff member(s) while traveling from the departure site to the destination site, and from the destination site to the return site.
|b)||I understand that it is within the school’s discretion to change travel, accommodations and other arrangements as it deems necessary. I will be informed of such changes as soon as practicable.
|c)||I understand that the school in arranging for my child’s travel and accommodation selected commercial airlines, trains, restaurants, hotels and other services whose performance and service cannot be controlled by the school. Consequently the school is not responsible for the actions of these commercial entities, including but not limited to lost luggage, unsatisfactory quarters, and refunds.
|d)||I understand that my child is expected to behave responsibly and to follow the school’s discipline code and policies.
|e)||I agree and understand that I am responsible for the actions of my child, and I release the school from all claims and liabilities that arise in connection with the trip, except if due to the negligence of school officials.
|f)||I understand that students who violate the school’s discipline code may be excluded by the school from participating in a trip. Additionally, I understand that if a serious or reported violation occurs while on the trip, it is within the school’s discretion to send my child home from the program, of which I will be informed. I understand if my child is sent home early, I am responsible for all costs associated with such early departure and forfeit any monies paid that are not refunded to the school.
|g)||I understand that students who violate the school’s discipline code may be excluded by the school from participating in a trip.
|h)||I confirm that my child is medically fit and able to participate in the trip described above. I have indicated specific activities, including water related sports and events in which my child may not participate: _______________________________________________________________________________________
|i)||I understand that as parent if I believe it is necessary to limit my child’s activity to a great extent, then the school may not able to accommodate my child on this trip and that I and my child will be informed of this decision as soon as possible upon the receipt by the school of this completed consent form.
|j)||I have indicated below any permanent or temporary medical or other condition(s) including special dietary and medication needs, or the need for visual or auditory aids, which should be known about my child:
|k)||In an emergency I can be reached at:
Day phone: (_ _ _) _ _ _ – _ _ __ Evening Phone: (_ _ _) _ _ _ – _ _ _
Additional Contact: Name ______________________________________
Day phone: (_ _ _) _ _ _ – _ _ __ Evening Phone: (_ _ _) _ _ _ – _ _ __
|l)||I give my permission for my child to participate in this school trip.
(Signature of Parent/Guardian) (Date)
I have read the Parent Notification/Consent Form and I understand that I am to act on this trip in the same responsible manner in which I am expected to conduct myself in school. I understand that alcoholic beverages and/or illegal drugs of any and all kinds are strictly prohibited and that if I am found in possession of these substances, I will be subject to school disciplinary procedures and possible criminal prosecution.
(Signature of Student) (Date)