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* 1. My name is

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* 2. I am the parent or legal guardian of [name the child].

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* 3. My relationship to this child is

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* 4. My child plans to be a part of the Connecticut History offering during Winterim 2019. As a part of this offering, Mr. Mack will drive participants to various historical venues within 30 miles of CHS. I grant Mr. Mack, an approved CHS driver, permission to take my child to/from these field trip venues.

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* 5. My child plans to be a part of History of Baseball during Winterim 2019. As a part of this offering, Mr. Bair and Mr. Vinton will drive participants to the National Baseball Hall of Fame and Museum in Cooperstown, New York.  I grant Mr. Bair, an approved CHS driver, permission to take my child to/from the Baseball Hall of Fame in  Cooperstown, NY.

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* 6. My child plans to be a part of the Microboard Processing, Inc. (MPI) Internship that is happening during Winterim. As a part of the program, students will carpool with CHS-approved chaperone to MPI and work from the company's office (36 Cogwheel Ln, Seymour, CT 06483).  I grant an approved CHS driver permission to take my child to/from MPI.

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* 7. My child plans to be a part of the"Recording Vocal" program that is occurring during Winterim. As a part of the program, students will carpool with CHS-approved chaperone to a recording studio with Dave Edwards, a CHS parent, and record within that studio in Stamford, CT.  I grant an approved CHS driver permission to take my child to/from the recording studio.

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* 8. My child plans to be a part of the"Documenting Winterim" program. As a part of the program, students will carpool with CHS-approved chaperone to an Escape Room.  I grant an approved CHS driver permission to take my child to/from the Escape Room on the final day of the course.

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* 9. My child plans to be a part of "Playwriting Intensive" program that is occurring during Winterim. As a part of the program, students will carpool and then ride the train with CHS-approved chaperone to NYC on one day to attend a play, and talk with real playwrights.  I grant Ms. Clohan, an approved CHS driver, permission to take my child to/from New York City for this event..

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* 10. My child plans to be a part of the curling Winterim on January 2 and/or January 7. I understand that an approved CHS chaperone will provide transport to and from the Nutmeg Curling Club and that the students will be under supervision of NCC employees and volunteers while on the premises. I grant permission for this transportation and supervision.

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