ASTORIA PARK ELEMENTARY SCHOOL GIFTED AND TALENTED PROGRAM

Student Permission and Information Form

By completing and signing this form, I am giving my child permission to attend Astoria Park Elementary’s Gifted and Talented program for this semester.

_________________ ______________________________________ ______

Date Regular Teacher’ Grade

________________________________ ___ ________________________________

Student’s Name Parent’s Name

_______________________________________________________________________

Home Address

Parent’s E-mail Address (please print clearly)

_________________________________ _________________________________

Day Phone Evening Phone

Allergies or other special considerations

Please check all that apply:

Field Trip Permission

_____ My child has my permission to attend the field trip, on Nov. 12th, 9:15 a.m. – 1:30 p.m.,

to the Lively Aviation School and the Airport.

_____ I will be available to help chaperone the class field trip.

Home Computer and Internet Access

____ My child is able to use a computer at home and has Internet access.

____ We do not have computer, but I can take my child to the public library where he/she will be able to use a computer.

________________________________ __________________

Parent’s Signature Date

IF YOU WOULD LIKE YOUR CHILD TO PARTICPATE EACH WEDNESDAY IN THE GIFTED AND TALENTED PROGRAM, PLEASE RETURN THIS FORM AND THE “STUDENT INTERNET USE AND PERMISSION” FORM (ATTACHED) TO YOUR CHILD’S CLASSROOM TEACHER TOMORROW.