HAYES LEWIS ELEMENTARY SCHOOL

STLP PERMISSION FORM

PLEASE RETURN YOUR PERMISSION FORMS BY February15 !  You may return your permission forms to Mrs. Rhonda Gross or Mrs. Sandra Gross

Student Name: ______________________________________________________________

Grade: _______________________     Homeroom Teacher: __________________________

Parent(s) Name: ____________________________________________________________________________     

Address: _____________________________________________________________________

____________________________________________________________________________

Phone Number: ________________________    Email: _________________________________

The following adults are permitted to pick up my child:

1.                                                                                                      Phone:

2.                                                                                                      Phone:

3.                                                                                                      Phone:

______________________________________________________________________________

-        Meetings will take place on Thursday’s from 3:05 – 5:00

-        Photos/Videos may be taken of my child and used on the school website or in projects

I agree to the above and give my child permission to join STLP.

Parent Signature: _____________________________________Date: ____________________