McKelvie Martial Arts Permission Form 16/17

McKelvie Martial Arts Class 2016-17
Club Advisor: Michael Lipari, 9957090@bedfordnhk12.net & Alexandra Ferrelli, ferrellia@bedfordnhk12.net
Maximum Number of Students: Limited to 10 students

April 18, 3:30-4:30pm, Gymnasium
Pick up at 4:30 at canopy entrance

Martial arts classes will be taking place in the gym on April 18 after school. This is the second class after a great turnout the first time. Michael Lipari, an instructor from Bedford Martial Arts Academy, is offering classes that will test a new style of learning using animated tutorials to assist in instruction. Students can stay after school with parents' permission to take these classes. They will learn a small number of american kenpo techniques as well as a basic kenpo mentality by working with each other and learning from examples given. These lessons are meant for students with no martial arts experience and who did not take the previously offered class. There will be approximately 10 students in the class.

Parents: By completing the information below, you are giving your son/daughter permission to participate in the McKelvie Intermediate School Martial Arts Class Club. Clubs are filled on a first come, first serve basis.

IMPORTANT: Please note that beyond school hours the Nurse is unavailable. Our standard protocol will be to call 911 in case of an emergency.

Student's First Name *
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Student's Last Name *
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Student's Homeroom Teacher *
Parent/Guardian Contact 1 *
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Parent/Guardian Contact 1 Phone *
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Parent/Guardian Contact 1 Email Address
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Parent/Guardian Contact 2
Please add a secondary contact, if desired
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Parent/Guardian Contact 2 Phone
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Parent/Guardian Contact 2 Email Address
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Health Issues/Allergies
Please list any health issues that you feel are essential for the advisor to know during the course of this club/activity.
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Parent/Guardian Permission *
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