Soap Box Club

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Soap Box Club

STANWOOD – CAMANO SCHOOL DISTRICT NO. 401
THIS FORM MUST BE COMPLETED IN FULL TO PARTICIPATE

*Club will begin on Thursday March 14, 2:30-4 in Mr. Rochon's room

Student Last Name *

Student First Name *

Student Grade *

6th

7th

8th

Best email address to use when contacting parent/guardian *

Address *

Guardian #1 (Name & Best Contact #) *

Guardian #2 (Name & Best Contact #) *

In an emergency, if parents/guardians cannot be contacted, notify the following, who has our permission to give medical release (Name & Best Contact #): *

Family Doctor & Phone # *

Preferred Hospital *

Known Allergies or Chronic Problems *

I, the guardian of the above named student, hereby give permission for the coaches, athletic trainer, and other appropriate school district personnel to use their own judgement in securing medical aid, ambulance service, and the release of any medical recored they deem necessary for the treatment of my student. *

Yes

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