INTRAMURAL SPORTS PERMISSION SLIP

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TO: Parents of Students in Grades 5 & 6

FROM: Kyrstin Bervert

DATE: September 1, 2023

Intramural sports are offered each year for 5th & 6th grade students to participate in, the fee is $25.00 per year. Our first session is a combination of soccer, kickball and pickleball. If your child is interested in the soccer/kickball/pickleball session, you will need to fill out the permission form below and submit it with $25.00 to school by Friday, September 15th. (Without this permission form being submitted completely and payment made, your child will not be able to participate). The session will run from Monday, September 18th through Monday, October 16th. Practice will be held BEFORE school every Monday, Tuesday, and Friday from 7:45am to 8:45am for both boys and girls. Participants should not be dropped off prior to 7:45am..

Each student is responsible for his/her own transportation. Supervision for your non-participating students is not available.

The school district provides insurance for students while they are participating in school sponsored activities. It is a co-insurance with your family policy and the coverage is limited. Please read the certificate of coverage handed out at enrollment.

INTRAMURALS is designed to be a fun program for all levels of physical abilities. This fall session will offer soccer/kickball/pickleball activities. This program requires students to exhibit appropriate behavior during the limited one-hour activity. This will allow our coaches and students to cover more of the basic fundamentals of the sport. Students who are unwilling to follow coaches' instructions will not be allowed to continue the program.

Does your student have permission to participate in the Intramurals session of soccer/kickball/pickleball? *

YES

Child's First Name *

Child's Last Name *

Child's Gender *

Male

Female

Child's Grade *

5th

6th

Child's Teacher *

Bautista

Hayen

Helmke

Scharrer

Watson

Wooten

Parent First Name *

Parent Last Name *

Parent Contact Number *

Emergency Contact First Name *

Emergency Contact Last Name *

Emergency Contact Phone Number *

I understand that the program will start on Monday, September 18th and run through Monday, October 16th. Practice will be held every Monday, Tuesday, and Friday BEFORE school, from 7:45am-8:45am, for boys and girls. *

YES

I understand that the school does not provide transportation for my child, and in order for him/her to participate it will be my responsibility to provide transportation. *

Yes

I understand that Intramurals participants should not be dropped off prior to 7:45am. *

YES

I understand that if my child is consistently being dropped of prior to 7:45am for Intramurals, my child may be removed from the program. *

YES

I understand the school does not provide supervision of non-participants. *

YES

I understand that the one time yearly fee of $25 for Intramurals will need to be sent to the school office, or paid over the phone via credit/debit card, prior to my child starting the program. *

YES

Parent Signature: Typing your name below stands for your signature and permission for your child to participate in the Intramurals session of soccer/kickball/pickleball. *

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