LETTER OF INTENT TO TRAVEL 2014 S T . L OUIS M USIC T OUR Due with $150 NONREFUNDABLE deposit on/before January 8, 2014 Return to your child’s music teacher in a sealed envelope I, _____________________________________, give permission for _____________________________________ (parent/guardian name) (participant name) to travel with the Gwendolyn Brooks Fine Arts Music Department to St. Louis, MO May 16-18, 2014. We have attended the informational meeting and/or have read the St. Louis Music Tour informational packet with our child and understand the following: • •

• •

•

•

The total cost of the trip is $450 dollars and have attached with this form payment of the $150 NONREFUNDABLE deposit. The St. Louis Music Tour payment schedule (as outlined on page 6 of St. Louis Music Tour informational packet) and will make payments on time. I understand that the remaining balance ($300) can be paid in full or in two installments ($150 each) If payments are delinquent, my child may lose the privilege to participate on the trip. (Please read cancellation policy on page 6.) The student ineligibility requirements and the consequences (cancellation) of not being able to participate if D97 academic and disciplinary requirements and/or behavior expectations of the Brooks Music Staff are not fully met. The student behavior expectations and trip guidelines (page 5) for the St. Louis Music Tour Trip. Appropriate consequences will be assigned for infractions that occur throughout the duration of the trip. Pending seriousness of infraction, consequence assignment may be postponed upon arrival to school (i.e. suspension). The penalty for cancellations on/after February 21, 2014 will be $84 and cancellations after March 19, 2014 will receive no refund. (Per Bob Rogers Travel Company) _____________________________________ Parent/Guardian signature

________________ Date

____________________________________ Student signature

________________ Date

Participant’s Music Ensemble: (circle) Student’s T-Shirt Size (Adult Sizes) Please Circle One: Small

BAND

Medium

CHORUS

Large

ORCHESTRA

X-Large

Address: __________________________________________________________

XX-Large

Zip Code:_______________

Home Phone:________________________ Parent/Guardian Cell Phone:________________________________ Parent/Guardian Email Address: ________________________________________________________________ Fundraising (Check One) _____ YES PLEASE! We want our child to participate in fundraising efforts to help pay for this trip. _____

NO THANKS! We do not want our child to participate in fundraising efforts to help pay for this trip.