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21st Century Field Trip Permission Form- The Illusionists Magic Show SUNDAY March 3, 2019 at West Point from 1:15-5:45 PM
The 21st Century After-School Academy will be hosting a field trip to the Illusionists Magic Show at West Point, NY. EACH SCHOOL IS LIMITED TO 20 CHILDREN and 1 ADULT PER CHILD ON A FIRST COME FIRST SERVE BASIS. You will "ONLY" be notified if your child's application is one of the first 20 applications that are received". If you are confirmed for the trip and do not attend, your child will not be eligible for the next field trip. SIBLINGS ARE NOT ALLOWED! UNACCOMPANIED CHILDREN WILL BE SENT HOME!

EVERY CHAPERONE MUST have Photo IDENTIFICATION with them ON THE DAY OF THE TRIP and provide that information ahead of time in order to go to attend the trip. If you do not have Photo ID with you will not be allowed in to see the show due to strict security procedures at West Point.

IN ORDER FOR US TO CONTINUE TO PROVIDE SERVICES WE NEED FAMILIES TO COMPLETE THE FAMILY SURVEY PLEASE GO TO https://tinyurl.com/2018-Family-QSA-1

Child's School *
Legal Name of person completing this form *
Your answer
Relationship to child *
Child's First Name *
Your answer
Child's Last Name
Your answer
Child's Current Grade *
Child's Daytime School Teacher Name *
Your answer
Name of adult family member attending the trip with your child *
Your answer
Telephone number of adult attending the trip with your child *
Your answer
Emergency contact number *
Your answer
I understand that food WILL NOT be provided for this trip *
Required
I understand that this trip is on a SUNDAY AFTERNOON *
If my child's application is selected, I understand that a call will be made to the adult chaperone and a verbal confirmation must be obtained in order for my child to attend the field trip. (If you do not hear from us your application was not selected) *
I give my child permission to attend the trip and to ride the school bus with a family member and 21st Century staff *
I understand that I will be notified "ONLY" if my application is accepted *
I understand that I need to provide the state Identification information of the chaperone in order for that person to attend the trip. Please Check the type of Identification provided *
Required
Please provide the Driver's License or State ID number of the adult attending the trip *
Your answer
I understand that the adult attending the trip must have their photo Identification with them on the day of the trip. *
I UNDERSTAND THAT THE FAMILY SURVEY IS A FACTOR IN THE PROGRAM BEING ABLE TO PROVIDE CONTINUED SERVICES FOR MY CHILD Please go to https://tinyurl.com/2018-Family-QSA-1 TO COMPLETE THE SURVEY *
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