Rockaway Development & Revitalization Corporation Education, Employment & Career Development Services (EECDS) In-School Youth (ISY)

Program Madame Tussauds Wax Museum Trip

Featuring Wax Figures of your favorite

Actors and Actresses Marvel Super Heroes

Music Artists

Sports Athletes

Get Your Camera Ready!!

When
February 20, 2014 Departing from RDRC at 9:00a.m. Returning to RDRC at 6:00p.m.

Cost
$21 per person

Where
Madame Tussauds 234 West 42nd St. between7th & 8th Avenues

Register Early
Register by Wednesday February 12, 2014
(Parental/Guardian Field Trip Consent Form on Reverse Side)
RDRC IS AN EQUAL OPPORTUNITY ORGANIZATION
1920 Mott Ave, Far Rockaway NY, 11691 (Phone) 718-327-5300 (Fax) 718-327-4900 Auxiliary aids and services are available upon request to individuals with disabilities TTY/TDD 1-800-662-1220/Voice Relay 1-800-421-1200

ROCKAWAY DEVELOPMENT & REVITALIZATION CORPORATION Education, Employment & Career Development Services (EECDS)

PARENTAL/GUARDIAN FIELD TRIP CONSENT FORM

Deadline: 02/13/2014 The Rockaway Development & Revitalization Corporation (RDRC) In-School Youth (ISY) Program participants will attend a Field Trip on Wednesday, February 20, 2014. Students will meet the RDRC staff at 1920 Mott Avenue at 9:00 AM and proceed to Madame Tussauds 234 West 42nd St. between 7th & 8th Avenues, New York, NY 10018. Expected return time to 1920 Mott Avenue is 6:00 PM. Please provide travel arrangements to ensure your child returns home safely. This project will be overseen by Mrs. Leonor Reina, Site Director, and Ms. Yolanda Boatwright, Program Assistant. Participants will receive free transportation and free refreshments.

Your child __________________________________, has been selected to attend this activity, provided that we receive your permission. I hereby give permission to RDRC to chaperone my child(ren) ____________________ for the above named activity. I understand that my child must follow the directives of the RDRC personnel to ensure their safety and the safety of others. I will not hold RDRC responsible for any accident or injury that may occur to my child during this activity due to their negligence, irresponsible behavior or failure to follow instructions. Please list any health condition(s) that you feel we should be aware of. In the event of a medical emergency, I _______________________ provide consent to RDRC staff to take my child ________________________ to the closest hospital. List any specific information that you would like us to relate to medical personnel. ______________________________________________________________________________ __________________________________________________________________ _____________________________ Parent Name (please print name) _____________________________ Date ______________________________ Parent Signature ______________________________ Day-Time Phone Number Emergency Tel. No. _____________

RDRC IS AN EQUAL OPPORTUNITY ORGANIZATION 1920 Mott Ave, Far Rockaway NY, 11691 (Phone) 718-327-5300 (Fax) 718-327-4900 Auxiliary aids and services are available upon request to individuals with disabilities
TTY/TDD 1-800-662-1220/Voice Relay 1-800-421-1200