Parent/Guardian Permission Form Student must have permission form on file to participate in the college visit.
In-Person College Visit | Tuesday, March 5th | Wake Forest University & NC State University 8:30 a.m. – Check in @ Crosby Scholars office, 2701 University Parkway, Winston-Salem, NC 27105 • Please arrive by 8:30 a.m. The bus will depart promptly with or without you. 9:00 a.m. – Campus visit at Wake Forest University – Lunch provided by Crosby Scholars Program 2:00 p.m. – Campus visit at NC State University 6:00 p.m. – Pick up @ Crosby Scholars office, 2701 University Parkway, Winston-Salem, NC 27105 • Please have a ride arranged for 6:00 p.m. when we return to the Crosby Scholars office.
I give my student, _____________________________________ (STUDENT NAME), a student at _________________________________________ (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 (6:00 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, Wake Forest University, NC State University, 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.
Return form via email, fax, or text to:
Senior Program Team | seniorprogram@crosbyscholars.org | 336-725-1321 (fax) | 336-671-5494 (cell) The Crosby Scholars Community Partnership | 2701 University Parkway, W-S, NC 27105