Permission Form
For Jr. High Dance
7/8th Graders graders are invited to a Jr. High Dance hosted by the Squires Circle 5423. The dance will be held on October 5th from 7-10:30 pm at the Knights of Columbus Hall, 121 Lakewood, Chatham. Entry fee is $5.00 and students must bring this form in order to enter the dance.
No student is allowed to go outside the building once admitted to the dance. If a student leaves the building, they will not be allowed back inside.
Further, no student is allowed to leave the dance without a parent coming to the door to get them. If your student is leaving with another parent, note the name/phone number of the parent picking them up on this permission form.
[Lakewood is East of the Baseball Field's there go straight to KNIGHTS OF COLUMBUS 4179 in CHATHAM
Visit our dance website @ squries5423.yolasite.com
I give permission for my student __________________________________________
(first/last name) to attend the Jr. High Dance.
____________________________________________________________
(name and phone number) will be picking my student up after the dance.
Student Signature/Date - ___________________________________/______/___
Print- ________________________________/____/___
Grade 7 or 8
Parent Signature and Date
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Would you like to help chaperone? If so, please contact Dale Smith at 529-9003 or shelby71@sbcglobal.net (Any Questions Also Contact Dale Please)
