EXAMPLE OF A 
5^th GRADE – FROM SPRING 2006
IRVING SCHOOL NATURE AND SCIENCE CLUB
REGISTRATION FORM

Please return to the Irving School office.

Registration for the Wednesday club is limited to 5^th graders at Irving School and is first come, first served.  

Student’s Name:  ___XXXXXXXXXXXXXXXXXXX___

Teacher:__XXXXXXXXXX__ 

Parent/Guardian’s Name:__XXXXXXXXXXXXXXXXX___

Parent’s Daytime Phone:___XXXXXXXXXX___

Email address:____XXXXXXXXXXXXXXXXXXXXXXX____

I give permission for my child, ____XXXXXXXXXXXX___, to participate in the Irving School 5^th-Grade Nature and Science Club on Wednesdays, May 17, 24, and 31.  I also give permission for my child to take walking trips around the Irving School grounds, assist with rocket launches, and handle small live animals—all with adult supervision.

Enclosed is _______.  There is a $15 fee for materials payable in cash or by check made payable to Irving PTO.  Financial assistance is available for students eligible for the free or reduced-fee lunch program.

___ My child is eligible for free or reduced lunch, so please waive the Nature and Science Club fee.

_______                ________________________________
Date                        Parent/Guardian Signature

If disability-related accommodations are needed, please contact Eric Gyllenhaal at 708-848-3083 at least one week before the first meeting.

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