Oak Harbor School District
Parent Permission for Participation in
Elementary After School Sports Program
SOCCER
Dear Parent and/or Guardian,
The Elementary Physical Education teachers are continuing the co-ed after school sports
program for all 4th and 5th grade students. The sports will include “Soccer” in the Fall,
“Volleyball” in the Winter, and “Cross Country” in the Spring. Your child can
participate depending upon their interest. Students will have two practices to begin the
season and will then have practices on Tuesdays and games on Thursdays against various
Elementary schools. The first practice for Soccer will be on Thursday, September 17th
from 3:30 p.m- 4:30 p.m. The first Game will be on Thursday, September 24th from 4:00
p.m- 5:00 p.m. A practice and game schedule is on the back of this form. Mr. Webster,
our traveling PE teacher in the Oak Harbor School District will be coaching soccer this
year. Parents will be responsible for picking up their child from school after
practices and transporting them to games held at various Elementary schools in the
district.
--------------------------------------------cut here----------------------------------------------------Please complete and return to your child’s Physical Education teacher, Mrs. Smedley.
I give permission for ______________________________________________________
To participate in after school Soccer on Tuesdays and Thursdays from September 17th to
October 22nd.
Student’s Address_____________________________City________________________
Student’s Home Phone #________________________Date of Birth_________________
Parent Name__________________________________E-mail _____________________
Family Physician______________________________Phone #_____________________
Medical conditions, medication information or allergies we need to be aware of:
________________________________________________________________________
In the event of an emergency, I wish the following person to be notified in case I cannot
be contacted:
____________________________________________Phone #_____________________
I understand every effort will be made to contact me to explain the nature of the problem prior to any
treatment involved, however, in the event of injury or serious illness, I authorize a qualified
physician/surgeon to examine and administer emergency care to the above named student.
RELEASE: In signing this release, I agree to absolve and hold harmless all sponsors, their officers and members,
and any other parties connected with this event in any way from and against any blame or liability for any injury,
misadventure, harm, loss, inconvenience, or damage suffered as a result of participation in these events.
___________________________ ___________________ ______________________
Signature of Parent/Guardian
Date
Cell Phone #
BVE Soccer Schedule 2015
Thursday, September 17th: Practice 3:30-4:30pm
Tuesday, September 18th: Practice 3:30-4:30pm
Thursday, September 24th: Away Game @ CHE 4pm
Tuesday, September 29th: Practice 3:30-4:30pm
Thursday, October 1st: Home Game vs. OVE 4pm
Tuesday, October 6th: Home Game vs. HCE 4pm
Thursday, October 8th: Practice 3:30-4:30pm
Tuesday, October 13th: Practice 3:30-4:30pm
Thursday, October 15th: Practice 3:30-4:30pm
Tuesday, October 20th: Practice 3:30-4:30pm
Tuesday, October 22nd Away Game @ OHE, 4pm