Rich Square W. S. Creecy Training & Community Center
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Job Fair March 21, 2012
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Middle School Valentine Dance
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Center Staff Secured Site
Dance Registration
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Indicates required field
Name
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First
Last
Address
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Line 1
Line 2
City
State
Zip Code
Country
School
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Grade level:
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5th
6th
7th
8th
Parent/Guardian Name
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First
Last
Phone Number
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Emergency Contact Name
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First
Last
Phone Number
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I give my child permission to attend the Creecy Center Valentine's Middle School Dance that will be held Friday, February 10, 2012. I understand that students must attend the entire dance from 6:00pm to 8:00pm. All students must have a signed form to participate in the event. No child is allowed to leave the dance prior to 8:00pm. If a child must leave the dance, for any reason, a chaperone must be told and the parent will be called to pick up the child. The students must enter from the main entrance. The students will be dismissed from the main entrance promptly at 8:00pm/ Parents/Guardians must be at the center at 8:00pm to pick up their child at the main entrance. If you have any questions about the Valentine's dance, please contact Peggy Cary at 252-539-1045 or email,
[email protected]
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Online Signature:
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Parent/Guardians are ask to type in their first and last name.
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