5th Grade Intramural Permission Slip

                                                                    Intramurals

                       5th Grade - Thursdays October 19, 2023 –March 28, 2024

Meeting dates- 10/19, 10/26, 11/2, 11/9, 11/16, 11/30, 12/7, 12/14, 12/21, 1/4, 1/11, 1/18, 1/25, 2/1, 2/8, 2/15, 2/29, 3/7, 3/14, 3/21, 3/28.

                                     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 *
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 .
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