Middle School Student Request Form - The Art of the Possible: Overcoming Adversity - 10/14/16

Use the following form to provide a list of Middle School students who will attend "The Art of the Possible: Overcoming Adversity" at Delaware County Christian School on Friday, October 14, 2016. More information about the program, and a link to "register" and pay, can be found by visiting http://tinyurl.com/2016-Robb-Armstrong. Please note: Schools must provide a signed permission slip/release form to ADVIS in advance of the event for all of the students listed below. All student permission forms should be sent in advance to Mary Cardona at maryc@advis.org or to the following address: Association of Delaware Valley Independent Schools, 701 W. Montgomery Avenue, Bryn Mawr, PA 19010

Limit 20 students per school. If your school would like to send more than 20 students, please call ADVIS at 610-527-0130 to be added to the wait-list.

Chaperone Contact Information: In the spaces below, please provide the name of the contact person at your school who is responsible for making arrangements to bring a group of students to this program. This person must also be a registered attendee. (Register here.)

Question Title

* 1. Contact Information:

First Name

Last Name

School Name

Title

Phone and extension

Question Title

* 2. Student Permission:

We agree that the following students have permission to attend "The Art of the Possible: Overcoming Adversity" on 10/14/16 at Delaware County Christian School, and that we will send all permission slips/forms for the following students to ADVIS in advance of the program.

Question Title

* 3. Middle School Student Names:

MS Student 1

MS Student 2

MS Student 3

MS Student 4

MS Student 5

MS Student 6

MS Student 7

MS Student 8

MS Student 9

MS Student 10

MS Student 11

MS Student 12

MS Student 13

MS Student 14

MS Student 15

MS Student 16

MS Student 17

MS Student 18

MS Student 19

MS Student 20

100% of survey complete.