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Wednesday, October 23rd. Important: Student(s) will not

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* Haunted House & More *

Permission Information
This page must be completed and returned to Earl Kitchener by Wednesday, October 23rd.
IMPORTANT: Student(s) will not be permitted to participate if this form is not on file.
I hereby request, as the parent / guardian of:

Print Name _______________________________________________

Room Number _______________________________________________
Teacher _______________________________________________

that he / she be permitted to participate in the Earl Kitchener Event – Fright Night - on Saturday, October 27th, 2012, 5:00 – 8:30 pm.

He / She wishes to help with (please check categories you are interested in):
Haunted House _____________
Game Room _____________
Other _____________
and would be available from : ____________________________________ (please indicate duration of time he/she is available to help – eg. 6 - 7 pm. A parent volunteer will contact you to confirm the shift they’ve been assigned.)

______________________________ ______________________________

Parent / Guardian Signature Date


Parent / Guardian

Please print name
Email Contact: _______________________________________________

(please print)

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