Disney Chaperone Interest form

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Please know that by filling out this form, you are showing you interest in being a chaperone on our 2022 trip. This does NOT mean you will be a chaperone. We will need to see who is interested and then find out how many rooms we need for males and female chaperones etc. You will be notified by Mrs. McAdam via e-mail IF you are chosen to be a chaperone. Thank you for your interest. Chaperone cost is $1000.00

First Name *

Last Name *

e-mail address *

cell phone number *

confirm your e-mail address *

child's name *

Child's year in school *

freshmen

sophmore

junior

senior

Please check the box confirming you understand the requirements of being a chaperone *

I understand that as a chaperone I will be responsible for 12-16 students. I will be required to contribute $1000.00 to the cost of my trip.

Required

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