Clio Area High School

JOB SHADOWING EXPERIENCE STUDENT REQUEST FORM

Student Name: ________________________________________ Phone: ___________________

Address: ______________________________________________________________________

Teacher Name: _________________________________________________________________

Career Pathway on EDP: _________________________________________________________

Career of Interest: ______________________________________________________________

(Please be as specific as possible)

JOB SHADOWING CHOICES

First Choice: ___________________________________________________________________

Second Choice: ________________________________________________________________

Third Choice: __________________________________________________________________

Have you Job Shadowed before? No____ Yes____ With whom? _________________________

METHOD OF TRANSPORTATION

Please indicate the method of transportation that you will be using to get to and from the Job
Shadowing Experience. Transportation will be your own responsibility.

Method of transportation: ________________________________________________________

PARENT/GUARDIAN PERMISSION FORM

I release Clio Area High School, its employees, and the participating business from any and all
liability resulting from an accident or injury which may occur during the Job Shadowing
Experience. I also acknowledge that the expense of any accident or injury is my responsibility.

I also understand that if I do not want my child to participate in the Job Shadowing Experience
due to weather conditions or other specific reasons, it is the students responsibility to inform the
Job Shadow coordinator and place of business.

Parent/Guardian Signature: _______________________________________________________

Parent/Guardian Name (Printed): __________________________________________________

Date: _________________________________________________________________________