Acknowledgment of Risk and Consent for Treatment for Minor Participants in Event or Field Trip

"*" indicates required fields

Student's Name*
  • Class/department: Education Studies
  • Field trip leader: Professor Rob Linné, 516.877.4411
  • Field trip destination: Adelphi University, Garden City Campus
  • Field trip date(s): July 14-19, 2024 (Monday-Friday, 10:00 am - 3:00 pm)
  • Equipment/supplies to be provided:
  • By participant: Notebooks and pen
  • Immunization required: N/A
  • Physical activities to be undertaken include: N/A
  • Risks inherent in this field trip include bodily injury due to: Students engaging in traditional classroom activities
(Include area code and extension, if applicable.)
Signature of Parent or Guardian*
MM slash DD slash YYYY
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