Job Shadow Information Sheet and Permission Form
Pleasant Knoll Middle School
Job Shadow Day, Tuesday, November 26, 2019
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To be completed by student:
First Name *
Last Name *
Homeroom *
Business Site Name *
Business City and State *
Business Contact Name *
Business Contact Title/Role *
Business Contact Email Address *
Business Contact Phone Number
To be completed by Parent/Guardian:
By electronically signing below, you agree to the following:    1) I will be responsible for arranging transportation for my child to and from the job shadow site.   2) I understand that I am responsible for my child during this time away from school.  I will not hold the business, the school, the school district, nor any employees of such organization liable for any injuries sustained by my child during the participation in this program.  I understand that school personnel will not be present when my child is at the work site.  3)  I give my permission for my child to receive emergency medical treatment in case of injury or illness while at the business site.  4)  I understand that all relevant paperwork must be completed on time in order for my child to receive an excused absence.
Parent/Guardian Name *
Parent/Guardian Phone Number *
Parent/Guardian Email Address
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