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712 Escape Room Field Trip

What: Escape Room

Location: Escape the Roomy NYC 24 WEST 25TH STREET, 8TH FLOOR, NEW YORK NY 10010

Date: December 16, 2024

Cost: $37.50

Ticket*

Price: $37.50

Student Last Name*

Answer Required

Student First Name*

Answer Required

Parent/Guardian Name *

Answer Required

Parent/Guardian Phone Number*

Number Required

Parent/Guardian Email Address*

Answer Required

Emergency Contact Name*

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Emergency Contact Phone Number*

Number Required

Chancellor's Regulation A-670 (School Trips): Parent Notification/Consent Form

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:

Write N/A if none needed.

Answer Required

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:

Write N/A if none needed.

Answer Required

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 activity, except if due to the negligence of school officials.

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 event.

Answer Required

j) I give my for my child to participate in this school event.

Signature of Parent/Guardian*

Signature Required

Confirmation Email

Confirmation Email *

Email Required