4th Grade Intramural Permission Slip

                                                                    Intramurals

                            4th Grade - Tuesdays October 17, 2023 –April 2, 2024

Meeting dates- 10/17, 10/24, 11/7, 11/14, 11/28, 12/5, 12/12, 12/19, 1/2, 1/9, 1/16,                                                  1/23, 1/30, 2/6, 2/13, 2/27, 3/5, 3/12, 3/19, 3/26, 4/2.

                                      *Intramurals will not meet on October 31, 2023.*

                                        Limited Capacity (lottery may be established!)        

  • Late Bus Available-Bus leaves front circle at 4:30PM

  • Late bus drops off students only at perimeter bus stops

  • Please see attached BUS RUN - Transportation Dept.–631- 791-4261

  • Parking in the front circle is prohibited. Please park to pick up your child at Crayons

  • Your child will be released to only those adults listed on the permission slip.

  • Please pick up your child by 4:20pm

  • Note is needed for any changes in adult pick-up instructions 

  • Must have sneakers to participate!

Email *
Student's Name *
Name of student's classroom teacher *
Parent/Guardian's Name *
Parent's Email *
Address *
Primary Contact Phone Number *
Emergency Phone Number *
If your child will be riding one of the late buses, please indicate below which bus stop they should get off.
*See bus stops*
Stops for Late Bus A

Or, please indicate below the name of the person(s) authorized to pick up your child.
 *
Parent/Guardian Electronic Signature
(Type Name)
 *
A copy of your responses will be emailed to .
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Port Jefferson UFSD. Report Abuse
Google Forms