Your student, ________________________, will be Career Job Shadowing at the following facility:

         Name:____________________________________________

         Address:__________________________________________

         Department:  ______________________________________

         Supervisor:  _______________________________________

         Phone:  __________________________________________

         Days:  ___________________   Times:  ________________
 

Due to the location of the facility, it will be necessary for your student to travel to the site via:

He/She will leave our campus at ________ and then, in turn, leave the Job Shadowing site at _________ to return to our campus or to your home.

 

Please provide the following information:

Your Automobile Insurance Company:  ______________________

 Your Automobile Insurance ID#:  __________________________

Please sign and date this form, then return it to our office to acknowledge your approval of this arrangement.

Parent Signature:  ______________________________
Date:  ______________