Excursions in Learning Health and Safety

If your child has any allergies, health conditions or special accommodations at school, please complete the Health Supplemental form and email or mail completed form to Linda Armstrong before filling out and submitting the form below.

Mailing address: Excursions Registration, MS #16, Manchester Community College, P.O. Box 1046, Manchester, CT 06045-1046

    Student Information

    Student Health Information

    Does your child have any allergies, health conditions or special accommodations at school? If yes, please complete the Health Supplemental form, including all medications your child takes.

    (If EpiPen, Benadryl®, inhaler or other medications may need to be administered during the Excursions program, please ask your child’s pediatrician for a signed medical authorization form and submit to Linda Armstrong, Excursions in Learning Coordinator.)

    Would you like the nurse to contact you before the program starts? (TAG Academy only)

    Additional Emergency Contacts

    If we cannot reach the child’s parents/guardians, who do we call next?

    Consent for Emergency Transportation

    In the unlikely event that reasonable attempts to contact the child’s parents/guardians and emergency contacts have been unsuccessful, I hereby give my consent for the Excursions in Learning nurse to arrange for emergency transportation and/or care. (required)

    Authorized Pick-Up in Addition to Parents

    Who can pick up your child? (In addition to the parents/guardians listed above, what other adults are authorized to pick up your child from Excursions in Learning?). These adults must show a photo ID to pick up your child.

    Photo Release - As part of our ongoing effort to promote the program, we may take photographs and video of children involved in learning activities. Do we have permission to photograph/film your child and place said photos/videos in advertisements, our catalog, our Facebook page and website? Names will not be used.