Elevate Bridgeport

College& Culture Tour 2026

Washington DC

April 6 through April 10

Student's First Name

Student's Last Name

Student's Phone Number

Student's Email

Student's Home Address

Parent/Guardian Full Name

Parent/Guardian Phone Number

Parent/Guardian Email

Emergency Contact Full Name

Emergency Contact Phone Number

Emergency Contact Email

What School do you currently attend?

What Grade are you currently in?

Is the student currently taking any medications?

yes

no

List any medications student is currently taking. If none, write none

Please list any allergies or health concerns that we should be aware of? If none, write none.

I give the above listed student permission to attend the 2026 College & Culture Tour to Washington DC with the Elevate Bridgeport Staff.

If time permits, we may be able to go to an amusement park. Do you give permission for the student to attend?

I will provide the Elevate Bridgeport Staff with a copy of the student's most current insurance card and provide accurate health related information.

I will attend the Mandatory Virtual Parent Information Meeting on Wednesday, March 18th @6:30pm to 7:30pm.

Divine ID