HATHERLY Elementary School -

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Please complete this form so your child can participate in the Scituate Elementary Schools GRADE 4 & 5 SPRING TRACK MEET on MAY 28th (Wednesday) starting at 4:00PM sharp st the Scituate High School Track!
[Rain Date is Thursday, May 29th].
EVENTS: 100M, 200M, 4x100M Relay, & a special 'Strong Kid' event.

Check below to confirm your child attends HATHERLY Elementary School. *

Yes, my child is a 4th or 5th grade student at HATHERLY Elementary School

Required

Check the box below if you:

* Give permission for your child to participate in the 4th & 5th grade Spring Track Meet.

* Realize you are responsible for their transportation to and from the event.

* If applicable, understand it is your responsibility to provide your child with their inhaler prior to the start of the event.

I have read above and provide permission for my child to participate.

Required

Grade of Student *

Student's Name *

Your Name (Parent/Cargiver) *

Your Relationship To Student *

Parent/Cargiver - Phone Contact Number *

Emergency Contact Name *

Emergency Contact's Relationship To Student *

Emergency Contact's Phone Number *

Name of Child's Physician *

Physician's Phone Number *

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