Jan 6, 2017 - Name of Event: Science & Technology Entry Program Annual Conference. Albany, NY ... Work or Emergency
PARENT PERMISSION FORM TO PARTICIPATE IN A FIELD TRIP Dear Parent or Legal Guardian, Your son/daughter is eligible to participate in a Binghamton University Science and Technology Entry Program (STEP) sponsored activity that requires transportation to a location away from the Binghamton University campus. Name of Event:
Science & Technology Entry Program Annual Conference Albany, NY
Designated Chaperones:
Dr. Shanise Kent, Co-director, JR Beckford, Program Assistant, Kierra Winston, Graduate Assistant
Date(s) 3/24/17
Time of Departure From: 12:30 PM Johnson City HS
Date(s) 3/26/17
Time of Return To: 3:00pm Sarah Jane Johnson Church
Please return permission slip to the principal’s office by Friday, January 6th, 2017. STEP will provide meals, accommodations and transportation for students attending
Method of Transportation: Coach Bus: TBD Accommodations: Albany Marriott, 189 Wolf Road, Albany, NY 12205 ____________________________________________________________________________________________________________________________
PARENT INSTRUCTIONS If you would like your child to participate in this event, please complete, sign and return to STEP the following statements of consent and release liability. I hereby consent to participation by my child, ___________________________________________, in Print Student’s Name the event described above and those activities set forth in the provided schedule. I understand that this event will take place away from the Binghamton University campus and that my child will be under the supervision of the designated STEP employee(s) on the stated date(s). I further consent to the conditions stated above on participation in this event, including method of transportation. Consenting to my child’s participation, I acknowledge my understanding that the University cannot be held responsible in the absence of its own negligence for events over which it has no control. I acknowledge that my child’s participation in this activity is entirely voluntary and that such participation involves risk of injury and property damage, including possibly short-term and long-term disability, and even death. These risks can come from causes that are many and varied, may not even be presently foreseeable, and may include negligent or intentional acts or omissions of others. I release the University and its trustees, officers, employees, agents and representatives from any and all claims he or she may have in the future, waive all such claims and agree not to sue the University or its trustees, officers, employees, agents and representative for any such claims, arising out of his or her participation in the activity, including but not limited to claims arising out of the negligent or intentional acts or omissions of others.
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Print Name of Parent/Legal Guardian
Signature of Parent/Legal Guardian
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Email Address
Work or Emergency Number
_________________________ Date
_________________________ Cell Phone Number
Students must submit a signed permission slip in order to participate in this event.
