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Dallastown Middle School Intramural Activity Permission Slip
Who: Middle School Students

When: Trimester 1 (Fall)

Where: DAMS

Time: 3:05-4:15

All Intramural questions should be directed to the activity's sponsor or Mr. Foust. Sponsors and/or the activity director reserves the right to make changes to dates and times.
Activity:
Student's First Name *
Your answer
Student's Last Name *
Your answer
Student's ID Number *
Your answer
Student's Grade *
Student's Homeroom *
Student's Date of Birth *
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DD
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YYYY
Student's Address *
Your answer
Parent/Guardian Name *
Your answer
Parent/Guardian Preferred Phone Number *
Your answer
Student's Medications *
Student's Medical Conditions *
Student's Physician Name *
Your answer
Student's Physician Phone Number *
Your answer
Check the appropriate mode of Transportation: *
Required
I, the undersigned parent or legal guardian of the above referenced student, hereby give permission for my child/student to participate in this school sponsored Intramural Activity. *
I ACKNOWLEDGMENT by signing this permission slip that should my child NOT be picked up by 4:15 pm, that he/she will ride the Activity Bus. (Please see Secondary Activity Bus Schedule https://dallastown.net/departments/transportation/bus_schedule *
Parent/Guardian Electronic Signature *
Your answer
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