Date____________________

I hereby give my son/daughter ____________________________________

permission to participate in the all or some of the scheduled can shakes that
will take place at the Lake Hiawatha Food Town, the first of which begins
on Sunday, January 11, 2009. I understand that additional dates have yet to
be determined.

Additional can shake dates:

(dates & parent initials listed below)
______________________
______________________
______________________
______________________

______________________________
Signature

______________________________
Parent/guardian’s name in print