RUSHVILLE CONSOLIDATED SCHOOLS

 

PARENT OR GUARDIAN PERMISSION TO PARTICIPATE IN SCHOOL ACTIVITY

 

POLICY NO. B  12160

 

 

 

 

SPECIFIC EVENT                                                      NAME OF CHILD

 

 

 

 

 

 

(Date of Event)

 

 

 

 

 

The undersigned parent or guardian of the above named child hereby consent to said child to participate in the above activity on or off the school property.

 

 

 

 

Date:

                                                                                       (Parent or Guardian’s Signature)