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* 1. My name is

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* 2. I am the parent or legal guardian of [name the child].

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* 3. My relationship to this child is

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* 4. My child plans to be a part of "Games" during Winterim 2019.

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* 5. My child plans to be a part of "Futsal" during Winterim 2019.

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* 6. My child plans to be a part of "Team Handball" during Winterim 2019.

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* 7. I grant permission to CHS for my child to participate in the above activities on January 2-4, 7, 2019,
at InSports,  29 Trefoil Dr, Trumbull, CT 06611. I grant approved CHS chaperones permission to transport my child to/from the venue and to take responsibility for my child during this/these off-campus excursions during the the Winterim program. Please write your name in the space provided to indicate that you approve.

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* 8. My child will do which of the following on each day?

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* 9. Please check boxes that apply. I grant my child permission to

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* 10. As is required by Insports, I have also completed the online waiver that is essential for all minors using the facility:   Insports Waiver

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