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2021 - 2022 WALKER FORM
Permission slip for students living in Cobblestone or Rosedale who walk home from school.
One permission slip per family
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* Indicates required question
Cobblestone or Rosedale
*
Cobblestone
Rosedale
Parent/Guardian Name
*
Your answer
Address
*
Your answer
E-Mail
*
Your answer
Daytime contact phone number
*
Your answer
Cell phone number
*
Your answer
Work phone number
Your answer
Student Name
*
Your answer
2020-2021 Grade Level
*
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Required
Student Name
Your answer
2020-2021 Grade Level
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Student Name
Your answer
2020-2021 Grade Level
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Cobblestone Manor Walkers- An adult from the list below will pick up my child from school each day at the Bus Lot Sidewalk at the front of school. (B hall side). PLEASE LIST NAME AND PHONE NUMBER
Your answer
Rosedale Walkers Please indicate the choice which the school should follow for how your child or children will get home.
*
My child has permission to walk home from school without adult supervision.
An adult from the list below will pick up my child from school each day at the Bus Lot Gate. See next question.
N/A My student is a Cobblestone Walker
Required
Rosedale Walkers - Name and Phone Number of Adult pick-up at Bus Lot Gate
Your answer
Date
*
MM
/
DD
/
YYYY
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