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Line Dancing Club

Student Information:

Last Name:*

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First Name:*

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Student's Grade:*

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Parent's Name:*

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Parent's Email:*

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Parent's Cell #*

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Please choose:*

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My student(s) will be picked up from the front of the school no later than 4:30 pm. (All student(s) remaining after 4:30 pm will be escorted to the extended care program.)

My student(s) need(s) to be escorted to the extended day program following the Line Dance Club at 4:30 pm

Type parent signature. I authorize Holy Family Catholic School to charge my FACTS account the registration fee for the Lego Club.*

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Date:*

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