Senior Community Service Day Permission

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Please complete by Thursday, April 6, 2023

Email *

Student First Name *

Student Last Name *

Student Cell Phone # *

Goverment Teacher *

Mr. Amedeo

Mr. White

Mr. Michel

Not enrolled in a JHS Government class at this time.

Other:

I certify that I am the legal parent or guardian of this student and give my permission for my student to participate in Senior Community Service Day on May 11, 2023. I understand that students must provide their own transportation or ride with another student with your permission. If no transportation is available, please contact Mr. Ziders and he will try to make arrangements. I further understand the school will not be held responsible for damages or student misconduct occurring off school property during the assigned service project. The Student Code of Conduct shall be followed on Senior Community Service Day. *

Yes

Guardian Electronic Signature *

Guardian Cell Phone # *

Date *

YYYY

In the past few years, parents/guardians have donated food and/or money for the luncheon to be held at the North Park Pavilion at 1:30. If you would like to donate please complete.

Monetary Donation - send to JHS Main Office - Attention: Sheryl Mazzeo

Donate 2-3 dozen baked goods for the luncheon(drop off May 11, 2023 by noon in the Main Office)

Assist with the luncheon set-up and/or serving

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