GSA Forms

All forms are PDF files and can be viewed using Acrobat Reader.

Forms are to be completed by June 15^th and returned to:

Virginia Governor's School for Agriculture
Virginia Tech, Mail Code 0343
175 West Campus Drive
Blacksburg, VA  24061

Note - Once all students have accepted their offer to attend the Governor's School for Agriculture, an email will be sent to students with an online survey to begin the registration process. Please complete forms below after responding to the online survey.

Please reference the Governor's School for Agriculture Handbook for any question you may have about the program.

The following forms need to be completed. Please use this checklist for reference:

• Parent/Guardian and Student Acknowledgement Form
  This form acknowledges that the student and parent/guardian have read the handbook and acceptable use guidelines.
• Student Information Sheet
  This form seeks to gain student contact and insurance information.
• Field Trip Permission Form
  This form authorizes parental permission for the student to participate in GSA field trips.
• Supervision Release Form
  This form offers parental consent for the student to leave campus unsupervised for short periods of time.
• Public Relations and Student-Created Work Consent Form
  This form gives parental consent for the release of student-created work for public relations purposes.
• Photo, Video, and Audio Recording Release
  This form allows photos, videos, and audio recordings to be made during GSA for use by GSA and Virginia Tech. 
• Parent or Guardian Waiver of Liability
  This form releases the Commonwealth of Virginia, the Virginia Department of Education, and Virginia Polytechnic and State University and their respective agents and employees from liability in the event of accident, harm, or injury.
• Authorization for Administering Prescription Medication
  This form authorizes the administration of prescription medication by the GSA.
• Medical Consent and Information Form
  This form gives the GSA parental consent to provide medical treatment.
• Montgomery Regional Hospital Admission Information
  This form deals with admission information for a hospital visit.
• Permission for Medical Treatment and Release of Medical Record Information
  This form gives parental consent for the Montgomery Medical Center to provide medical treatment.
• RSVP Information
  This form requests RSVPs for the Governor's School banquet.
• Permission to Use Student Assignments
  This form allows for student assignments completed in the Governor's School to be used for evaluation and improving of the Governor's School.
• Activity Fee Information
  This form documents payment of the activity fee associated with Governor's School extracurricular activities.
• Religious Services Information
  This form authorizes Governor's School staff to escort students to optional religious services, if selected by the student.
• Pick-Up Release Form
  If someone other than the student's parent or guardian pick them up during Parent's Weekend (July 8th and/or July 9th) or after graduation (July 22nd) a Pick -Up Release Form needs to be filled out.