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Hoffman/Mainolfi 2/27 Black History's Groundbreaking Geniuses Show

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Black History's Groundbreaking Geniuses Show

This show focuses on the brilliance of over a dozen amazing characters from Black History: Scientists like surgeons Daniel Hale Williams, mathematicians like Dorothy Vaughan, Literary Geniuses like Ralph Ellison and Maya Angelou, and artistic Geniuses like Alvin Ailey.

Trip Coordinator: Ms Mainolfi

Student's First Name:*

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Student's Last Name:*

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Class:*

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812

821

822

823

833

Trip Date: Thursday, February 27, 2025

Destination: St George Theatre

Departure: IS 27 at 9:30am

Return: IS 27 at 12:00pm

Transportation: Yellow school bus

Specific Clothing/ Equipment Required for this Trip: None

This trip will include the following physical and sports activities (e.g. swimming, horseback riding, ice skating, skiing, boating): None

a) I understand that there are risks of injury associated with the above-listed physical and sports activities and I consent to my child’s participation in all these activities except for the following: (NOT APPLICABLE)

b) Please indicate below any permanent or temporary medical or other condition, including special dietary and medication needs, or the need for visual or auditory aids, which should be known about your child:*

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c) I agree that in the event of an emergency injury or illness, the staff member(s) in charge of the trip may act on my behalf and at my expense in obtaining medical treatment for my child.

d) I understand that my child is expected to behave responsibly and to follow the school’s discipline code and policies.

e) I agree and understand that I am responsible for the actions of my child. I release the school from all claims and liability that arise in connection with the trip, except if due to the negligence of school officials.

f) I understand that I am responsible for getting my child to and from the departure and return sites identified above. I understand that my child shall be accompanied by staff member(s) during the trip, including while traveling from the departure site to the destination site, and from the destination site to the return site.

g) I understand that alcoholic beverages and/or illegal drugs are prohibited and have discussed this prohibition with my child. I understand that if my child is found in possession of these substances, they will be subject to school disciplinary procedures and possible criminalprosecution.

h) I understand that students who violate the school’s discipline code may be excluded in the future by the school from participating in a trip.

Parent's First Name:*

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Parent's Last Name *

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In an emergency I can be reached at: (Day time number)*

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Additional Contact: Name:

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Additional Contact: Phone Number:

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Parent's Digital Signature*

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STUDENT DECLARATION

(to be signed by Middle School and High School students)

I have read this form and I understand that I am to act on this trip in the same responsible manner in which I am expected to conduct myself in school.

Student's Signature*

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Student's Signature Date:*

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Payment *

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$12.00

Confirmation Email

Confirmation Email *

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