Carnival Themed Sup N Sing Permission Slip

Thursday, October 15, 2009

German Park

6-8p.m.

My daughter, ____________________________, has permission to attend the Oct. 15^th Sup-n-Sing at German Park from 6-8pm. In case of an emergency I can be notified at the number below:

Home ________________________ Cell____________________________

**If I can not be reached, please contact my emergency contact person listed below:

Name _________________________________________________________

Relationship_____________________________________________________

home _________________________ cell_____________________________

Dr.’s Name ______________________________ number _________________

Hospital preference ______________________________________________

---------------------------------------------------------------

Parent’s signature _____________________________ date______________

Number of girls attending ______ X $5.00 each = $ ________includes patch Number of adults attending ______X$3.00 each = $_________

Extra slices of pizza ___________X $1.00 each =$_________

Total $_________

# of slices of Cheese pizza ______ # of slices of pepperoni pizza ________