ECNC 2025 Freedom Schools Field Trip Permission Form

East Cleveland Neighborhood Center CDF Freedom Schools Field Trip Permission Form
Complete a separate enrollment form for each scholar.

If you have any questions, contact

Ms. Monica,

Freedom School Registration Coordinator at

216-932-3626 or mstreeter@ec-nc.org
1st Child's Information
Name*

First NameLast Name
T-Shirt Size *
What school does your child attend? *

Superior Elementary, East Cleveland, OhioCaledonia Elementary, East Clevealnd, OhioMayfair Elementary, East Cleveland, OhioKirk Middle School, East Cleveland, OhioShaw High SchoolOther
Does your child have any allergies or health conditions of which we should be made aware of? If yes, what?*
Is there anything else you would like to share about your child?*
Name of person completing this form*

First NameLast Name
Relationship to child(ren)*
Phone Number*

Area CodePhone Number
Emergency Contact Information
Emergency Contact Name:*

First NameLast Name
Phone Number*

Area CodePhone Number
Is this person authorized to pick up the child(ren) you enrolled in this program? *

YesNoN/A
In case of an emergency, I give permission for any of the above individuals to be contacted and my scholar may be released to any of them. Select one.*

Yes, I give permission.No, I do not give permission.
This summer we have planned field trips to the Holden Arboretum, the Botanical Gardens, the Auto Museum, the Science Center, and Pioneer Waterland. We will provide transportation for these trips. Do we have your permission to transport your scholar to these trips?*

Yes, I give permission to transport my scholar.No, I do not give permission to transport my scholar.
Though we prefer if someone picks up the scholars, we are aware that some of them are allowed to walk home. Do you give your scholar permission to walk home or to another program (like band)?*

Yes, I give permission for my scholar to walk home.No, I do not give permission for my scholar to walk home.
Please provide thew name of the PRIMARY person who will be picking the scholar up. (Type N/A if they are a walker.)*
Please provide thew name of the SECONDARY person who will be picking the scholar up. (Type N/A if they are a walker or there is no secondary person.)*
I understand that the organization enrolling my child in the CDF Freedom Schools program is in partnership with the Children's Defense Fund to offer this summer program. This personal information will be kept private and confidential and only be shared with CDF to collect demographic-served details and report the data in aggregate form. Additionally, I understand that ECNC and/or CDF may use my child's image, name, photograph, video, likeness, voice, and statements in connection with marketing, publicity, advertising; promotion, and publication purposes in any media, including, without limitation, print, videotape, CD/DVD, promotional materials, radio, television and Internet.
Signature*

Clear
Should be Empty:

East Cleveland Neighborhood Center CDF Freedom Schools Field Trip Permission Form

1st Child's Information

Emergency Contact Information