Parent/Guardian Permission Form
Student must have permission form on file to participate in the college visit.
College Visit | Thursday, July 27th | NC State University & William Peace University
8:15 a.m. – Check in @ Crosby Scholars office, 2701 University Parkway, Winston-Salem, NC 27105
Please arrive by 8:15 a.m. The bus will depart promptly with or without you
11:00 a.m. – Bus arrives at NC State University
12:30 p.m. – Lunch provided by Crosby Scholars Program
3:00 p.m. – Bus arrives at William Peace 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 (5:30 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, NC State University, William Peace University, and Sunway Charters 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.
Email address: