NATHAN HALE MIDDLE SCHOOL

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Permission Slip for Winter Intramurals

Print out this page and use it as the permission slip for your student to participate in an intramural activity.

 

_________________________has my permission to participate in ___________________________.

Address _____________________________________     Home Phone ____________  
Work Phone ______________________

Person to contact if parent cannot be reached ___________________________
Phone number ________________________  

Physician Name _______________________            
                                                                    Parent Signature ___________________________

 

 

176 Strawberry Hill Ave
Norwalk, CT 06851
(203) 899-2910

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