St. Rose of Lima Athletic Association

Soccer/Basketball/Cheerleading/Baseball/Softball/Volleyball

PERMISSION SLIP

My child has permission to participate on the St. Rose ____________________________team.

Please provide three checks, all made payable to “St. Rose of Lima”, in the following amounts:

League Fee: $50

Uniform deposit: $75

Service Deposit: $50

I also give permission for my child to be transported to away games by any adult who is associated with the team.  If you will only allow your child to ride with certain people, please list them here.

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Student's Name ________________________________________Grade ___________________

Parent or Guardian Signature _______________________________________________________