2023 Jan-Feb Intramural Dodgeball Form

Fill out this form completely and legibly & return with $30 payment to PTSA box in the front office by December 14, 2022.

Please make all checks payable to “Robert Frost PTSA”

Please direct all questions to Helen Wing: [email protected]

Mark One

  Kindergarten to 2nd grade January 5th to February 13th (No class 1/16) Mondays & Thursdays    3rd to 5th grade January 3rd to February 10th  Tuesdays & Fridays  

Name(s):   ________________________________________________________________

Grade(s) & Teacher(s): ______________________________________________________

Emergency Contact (Name): _________________________________________________

Parent Phone & Email: ______________________________________________________

Payment enclosed:            Cash ___________                       Check___________

I’m interested in chaperone K-2: ______________________

I’m interested in chaperone 3-5: ______________________

I’m interested in a free scholarship: ____________________