Download as doc, pdf, or txt
Download as doc, pdf, or txt
You are on page 1of 1

Cleveland Elementary School __________________________________________________________________________

Anne Burchill Williams, Principal Dr. Pamela J. Homan, Superintendent


1000 South Edward Drive
Siou !alls, South Da"ota #$10%
Ph& '(0#) %($*(1#0 !a& '(0#) %($*(0((
Date: ___________________
Student Name: ________________________
As the parent/guardian of the above named student, I understand that my child has elected to take part in
band/orchestra !aking part in this activity "ill remove my child from classroom instruction and may negatively
impact his/her future overall academic success
#eing fully informed of possible future implications for my child, I am re$uesting that he/she be allo"ed to take
part in band/orchestra
__________________________________
%arent/&uardian Signature
__________________________________
%rincipal Signature

You might also like