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PARENT/GUARDIAN CONSENT FORM
Your son or daughter has been invited to attend a Job Shadowing experience at a workplace. He/she will be assigned to an employee, a Workplace Host, who will lead him/her through a department in the workplace. They will discuss a typical workday and explore different aspects of working in a particular industry and what skills they are learning in school that are needed in the working world. They will then join classmates and workplace employees for a luncheon to discuss what they observed and learned. The student will receive a certificate of attendance. In order for your child to participate, this form must be returned to us before the day of the event.
Permission to participate in Workplace Job Shadowing
My son/daughter_____________________________________________, may participate in the
Job Shadowing, which will take place at Morristown Medical Center on___________________
between the hours of 7:30 a.m. and 1:30 p.m.
Permission to travel to the workplace
I understand that my son/daughter will travel to the workplace using his/her own transportation, unless other arrangements have been made by the school.
I understand that my child may be transported to other Atlantic Health System sites by Atlantic Health System transportation.
Photo Release
I understand that the Job Shadow Day attracts attention from the media and is also used to promote partnerships between schools and employers, so there is a possibility that students will be photographed during their experience. I grant permission to photograph my son/daughter:___________________________________________________________________
General Release
I hereby release Atlantic Health System, Inc., AHS Hospital Corp., and their respective officers, trustees, employee, agents and independent contractors, from any liability in connection with my child’s participation in the shadowing program. I understand that that I am waiving any claim that I may have against Atlantic Health System, Inc. and AHS Hospital Corp. arising from and relating to my child’s participation in this program. I understand that I am responsible for arranging for transportation for my child to and from the Hospital. I will discuss with my child the importance of appropriate behavior while on Hospital premises and understand that I may be required to pick my child up at the Hospital if he or she does not behave appropriately.
I hereby agree to all of the above authorizations and permission
________________________________________________________________________________
Signature of parent/guardian Date
Human Resources
475 South Street
Morristown, NJ 07960
T 973-660-3528 F 973-290-7147
Diane.schneider@atlantichealth.org
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