RECREATION & LEISURE

student and RECREATION

with this form, the undersigned veriff that the student:

& LEISURE Staff rnember

i"t"i;;J*i tr,t. Recreation & Leisure field'

Talkedwithafacultymemberandlorstaffmemberaboutresponsibilitiesofbeing
nd Recreation Programs:.Name

type

Name of event:: Participated in Intramurals at SCSU:

Date:
Date:

Time in: Time out: Total time:

tO: CCSrrt
I I ,CCGvIl

Time in: Time out: Total time:

Event:

thr

Staff Signature)

IOUNNEI, NOTES:

Hc+-ler-e

Lflirc.m*

J:cr3"183-328c