Field Trip Permission Student Name* First Last Student Date of Birth* MM slash DD slash YYYY Does the student have a photo ID?*Please choose the answer that best applies to your student. If the student has a driver’s license, please choose the first option. Yes, the student has a driver’s license Yes, the student has another form of photo ID No, the student does not have a photo ID Parent/Guardian Name* First Last Parent/Guardian Email* Parent/Guardian Phone*Emergency contact name/relationship to student*In the event of an emergency, the above parent/guardian will be contacted first First Last Emergency contact phone number*In the event of an emergency, the parent/guardian will be contacted first.Parent/Guardian Email* My child has permission to attend a field trip to a research facility on the Thursday of the cSw Virtual Boot Camp week.* Yes No Please check the location your child will visit.* AstraZeneca – Cambridge,MA AstraZeneca – Cambridge, MA Emory National Primate Research Center – Atlanta, GA National Institutes of Health – Bethesda, MD Icahn School of Medicine at Mount Sinai – New York, NY University of Michigan – Ann Arbor, MI University of San Francisco – San Francisco, CA University of Texas – El Paso – El Paso, TX University of Washington – Seattle, WA Wisconsin National Primate Research Center/University of Wisconsin, Madison – Madison, WI Virtual Research Facility Visit (Live visits via Zoom) My child is not able to attend this opportunity. Parents are responsible for ensuring their student is able to travel to the field trip location. All costs for travel (and accomodations IF applicable) are the responsiblity of the parent/student. A virtual option is available for those not able to travel to a physical location.I agree with the following statements (check all that apply):* I understand that me/my student is responsible for transportation to the field trip I understand that it is my/my student’s responsiblity to arrive on-time and depart when the event is over I understand that I must comply with all rules and procedures set by the hosting facility I understand that I must be respectful of others and the property that I will be visiting I understand that I may need to complete additional paperwork to comply with requirements of the hosting facility I understand that my permission includes handling life threatening emergencies according to the policies of the hosting institution I also understand that I will be contacted if an emergency involving my child occurs I understand that my child can attend a virtual visit if they are not able to attend an in-person opportunity SignatureYour typed name will be used as your signature indicating your permission for your student to attend a field trip as part of the Curious Science Writers summer boot camp experience.ComEmailThis field is for validation purposes and should be left unchanged.
