Parent Consent Form 2015-16 School Year

Blaine School

1420 W. Grace

(773) 534-5750

Parent Consent Form 2015-16 School Year

Elementary Sports

Parent/Guardian,

I give consent for my son/daughter_____________________ to participate in the Elementary School Sports Program. They will represent Blaine School playing ________________ (sport). There will be games played against other schools. Parents will be responsible for the students getting home after each game and practices. Game schedules will be sent home and listed on the Blaine website. In order to participate, your child must meet all academic requirements including classroom work, homework, and grades.

A misconduct report will result in immediate dismissal from the team. Student fees must be paid or fee waiver completed in order to participate in sports.

*Uniform Policy: Students will purchase a uniform for their designated sport upon completion of try-outs. This uniform will be used throughout their years at Blaine so please consider correct size to accommodate growth.

Thank you

Mr. Sikes and Ms. Harms

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Signature of parent or guardian_____________________________________

Print name of parent or guardian_____________________________

Child’s Name__________________________ DOB___________

ID#_________________________

Grade____________________ Class Number______________________

Address_____________________________________________________

Emergency Phone Number______________________________________

Please check one:

Walking home______ Pick up by parent_________ CTA______

I will be able to drive students to away games yes___________ no________

I would consider assisting with coaching e-mail__________________________