Summer Forms

 

Permission to Leave or Ride in a Vehicle

NOTE: Please do not submit forms before June 17, 2017.

Form must be submitted at least two days in advance.

Please fill out the form below that corresponds to your child's dorm. The submission of this form grants your child permission to leave or ride in a vehicle with another individual. Please do not submit a form until your child's dorm has been assigned on Arrival Day (June 17).

Click on the your child's dorm to comple the "Permission to Leave or Ride in a Vehicle Form"

Adams - adamsdd@cpyb.org
Drayer - drayerdd@cpyb.org
Mathews - mathewsdd@cpyb.org
Todd - todd-dd@cpyb.org
Witwer - witwerdd@cpyb.org

Having trouble with the above links? Simply copy and paste the following information into an e-mail and send to the appropriate dorm (addresses listed above):

Subject: Permission to leave or ride in a vehicle

Notification of a student’s permission to leave or ride in a vehicle must be received by CPYB at least two days in advance of the student’s departure from the dormitory. Complete and electronically sign the following form and e-mail it. Your e-mail will be directed to the appropriate residential staff.

PERMISSION TO LEAVE: 

I, ______________(ENTER CUSTODIAL PARENT/GUARDIAN'S NAME) give permission for ______________ (ENTER STUDENT NAME) to leave campus. My student is allowed to leave with myself or with any of the following person(s):

Name: 
Phone: 

Name: 
Phone: 

Name: 
Phone: 

PERMISSION TO RIDE IN A VEHICLE: 

I, ______________ (ENTER CUSTODIAL PARENT/GUARDIAN'S NAME) give permission for ______________ (ENTER STUDENT NAME) to ride in the vehicle(s) of the following individual(s) during the 5-Week Summer Ballet Program.

Name: 
Phone: 

Name: 
Phone: 

Name: 
Phone: 

**This form must be electronically signed and dated by the Custodial Parent/Guardian of any student under the age of 18.**
My electronically typewritten signature below shall be legally binding and serve in the same capacity as my original penned signature. 

SIGNATURE (type full name): 
DATE: