Strawbridge ES Permission Form to Participate in Before/After School Clubs

Please return this form to the club sponsor prior to attending the club
Please Print Information:

Student Name: First: ___________________________ Last__________________________

Homeroom Teacher:__________________________________________________________

Club Name:Morning Glory Garden Club Club Sponsor: Mrs. Lucka-Beristain

Club Start Date: March 17 Club End Date: June 11

Meeting Day:
☐ Mon X Tues ☐ Wed X Thurs ☐ Fri

Meeting Times:
Start:7:30 am End: 8:10
Depending on the weather! Dojo apps used to communicate cancellations. Please have
student bring a book to read from 8:10-8:20 in the foyer.

Why do you believe gardening is important?

________________________________________________________________________

Do you like to get your hands dirty and work hard as a team?

________________________________________________________________________

Are you in any other clubs? If so, what club/s

_________________________________________________________________________

___________________________ ______________________________
Parent/Guardian Name Daytime telephone and/or cell phone#

___________________________ ______________________________
Parent/Guardian email alternative parent/guardian email
___________________________ ______________________________
Emergency contact Daytime telephone and/or cell phone#

My child has permission to participate in the above after school club. I understand and agree
to provide transportation promptly at the activity’s conclusion. I understand, if I am late picking
up my child more than twice, they will be dropped from the club.

_____________________________________________________ __________________

Parent Signature Date