Parent/Guardian Permission Form
Student must have permission form on file to participate in the college visit.
College Visit | Monday, October 30th | Winston-Salem State & UNC Greensboro
9:00 a.m. – Check in @ Crosby Scholars office, 2701 University Parkway, Winston-Salem, NC 27105
Please arrive by 9:00 a.m. The bus will depart promptly with or without you
10:00 a.m. – Campus visit at Winston-Salem State University
12:30 p.m. – Lunch provided by Crosby Scholars Program
1:00 p.m. – Campus visit at the University of North Carolina at Greensboro
4:00 p.m. – Pick up @ Crosby Scholars office, 2701 University Parkway, Winston-Salem, NC 27105
Please have a ride arranged for 4:00 p.m. when we return to the Crosby Scholars office.
(STUDENT NAME), a student at _________________________________________
I give my student, _____________________________________
(HIGH SCHOOL NAME), permission to participate in the Crosby Scholars College Visits on the date marked above. I understand that I am responsible for providing transportation to and from the Crosby Scholars office. Further, I understand that it is my responsibility to arrange transportation for my student to be picked-up at the designated time, thereby releasing the Crosby Scholars staff of the responsibility of supervising my student after the conclusion of the program (4:00 pm). In the case of an emergency, I authorize the Crosby Scholars staff to seek the appropriate medical treatment for my child. I hereby release the Crosby Scholars Community Partnership, Goodwill Industries, Winston-Salem State University, the University of North Carolina at Greensboro, and the transportation provider of any liability in the event of accident or emergency.
In case of emergency, please contact (name) __________________________________ at (phone #) ______________________________.
I have listed my child’s special medical conditions below: ________________________________________________________________________ ________________________________________________________________________
Parent Signature: ______________________________
Date: _____________________
Please physically or digitally sign above- a typed name will not qualify as a signature.
Parent Email: ___________________________
Parent Cell #: ______________________
By providing your cell #, you agree to receive text message reminders.