Liv Co Job Shadow Day

Students must fill out the “Student” section of the form and Parents/legal guardians must fill out “Parent/Guardian” of the form (digital signature and initial below is required) in order to be eligible to participate in Job Shadow Day.

Register for Job Shadow Day and wait for confirmation that you received the slot.

Call/text employer night before to confirm visit.

Parents must call the attendance line the day of the visit or prior to excuse the absence and allow it to become school business.

STUDENT

First Name *

Last Name *

Student Email Address *

Student Email Address (confirm)

Student Phone *

Grade *

If grade is "other" please provide *

School Name *

If school is "other" please provide

Would you be willing to text with your mentor employer? *

Transportation Mode to Job Shadow *

Dietary or Allergy Needs

Physical or needs that employer should be aware of

What industries are you possibly interested in? *

Jobs/career areas are you currently interested in? *

Have you ever participated in a Job Shadow before? *

What are you hoping to learn in a job shadow? *

Host Teacher or Counselor Name *

PARENT/GUARDIAN

Parent/Guardian Name *

Parent/Guardian Phone *

If student has any health/behavior concerns that will impact the shadow, please indicate here: *

I will be responsible for arranging transportation for my child to and from the job shadowing site. My permission is given for my child to receive emergency medical treatment in case of injury or illness. I understand that school personnel will not be present when the student is at the work site. Additionally, student has my permission to travel to work sites away from original facility depending on the nature of the job. I am aware that all employees have not been background checked at this organization.

Parent Signature *

Today's date *

Parent initial (or student initial if over 18) authorizes Livingston Educational Service Agency and any participating employer to utilize student photographs in any publicity or promotional materials.

Parent initial (or student initial if over 18) *

If yes, where and what occupation did you shadow? *

Liv Co Job Shadow Day Registration + Permission

STUDENT

PARENT/GUARDIAN