Guardian ...
COLLEGE NOW at LaGuardia Community College Parent/Guardian Notification and Consent, Fall 2017 This is to acknowledge that my child, _______________________________________, is participating in The City University of New York’s College Now Program and that the instructional activities will take place at LaGuardia Community College, located at 31-10 Thomson Ave, Long Island City, New York 11101. College Now Classes will be held on Monday and Wednesday: 3:45 - 5:15pm, 4:00 - 5:30pm, 4:006:00pm or 4:30-6:30pm; Tuesday and Thursday: 3:30 - 5:00pm, 3:45 - 5:15pm, 4:00 - 5:30pm, or 4:006:00pm; or Saturdays: 8:00 – 11:30am or 9:15 – 12:15pm. See enclosed Fall 2017 College Now Course Schedule, from 9/7/2017 – 12/9/2017. I give my child permission to travel from high school to LaGuardia Community College to home, as well as to any scheduled field trips, by public transportation, and unaccompanied. I agree not to hold College Now, LaGuardia Community College or any Faculty or Staff responsible for any emergencies, injuries or illnesses that may occur during this trip. I understand that my child is responsible for his/her behavior at all times. In order to help promote the College Now program, I hereby grant permission to the College Now program at LaGuardia Community College to use my child’s: __ Image or photograph __ Name __ High school affiliation __ Written and/or recorded oral statements made in or about College Now Solely for CUNY’s non-commercial purposes, including promotion of the College Now program and use on CUNY TV and cuny.edu, in any manner or media, now and in the future, throughout the world. YES __ NO__ _____________________________ Signature of Parent/Guardian
__________________________ Date
_____________________________ Printed Name of Parent/
__________________________ Guardian Home Telephone
_____________________________ Cellular and or work phone
__________________________ Email Address
_____________________________ Name of Emergency Contact
___________________________ Emergency Contact Telephone
I consent to the use of my image of photograph, name, high school affiliation, and/or written and/ or recorded oral statements made in or about College Now as described above.
____________________________ Signature of Student
___________________________ Printed name of Student Date
__________________________ Date
_____________________________ Printed Name of Parent/
__________________________ Guardian Home Telephone
_____________________________ Cellular and or work phone
__________________________ Email Address
_____________________________ Name of Emergency Contact
___________________________ Emergency Contact Telephone
I consent to the use of my image of photograph, name, high school affiliation, and/or written and/ or recorded oral statements made in or about College Now as described above.
____________________________ Signature of Student
___________________________ Printed name of Student Date
