Community Service Club Permission Slip INSTRUCTOR: Mr. Vaillancourt CLUB NAME: Community Service Club: Late Fall/Winter Session DESCRIPTION: Students will participate in a variety community service projects and fundraising activities. All activities are designed to develop leadership skills, improve self-esteem, as well as make our school and community a better place. Past activities have included: coordinating the Galvin toy drive, assisting with the Salvation Army Bell Ringing Campaign, selling hot chocolate to raise money for charity, selling candy-grams to raise money for charity, collecting food items for the Wakefield Interfaith Food Pantry, supporting troops overseas with letters and donations, reading to preschool age students at the Beebe Library, and volunteering at the elementary after school programs, as well as students designing and implementing their own service projects.

GRADES: 5-8 Most meetings will take place on Mondays. There will be occasional Tuesday meetings. Please see the list of meeting dates below: T 11/15, M 11/21, M 11/28, M 12/5, M 12/19, T 1/10, T 1/17, M 1/30, M 2/13, M 2/28 (additional dates for March will be added after winter vacation) Meeting Times: Meetings will take place from 2:30-3:30 after school. Students may have the opportunity to participate in additional volunteer activities that take place outside of scheduled meeting times.

Please Detach at Dotted Line and return to Mr. Vaillancourt. Keep above portion for your own records

------------------------------------------------------------------------------------------------------------------------------------_______________________ Student Name

_____ Grade

_____________________________ HR#/HR Teacher

_______________________ Parent/Guardian Name

_____________________________________ Best Phone # to Reach 2:30-3:30

_______________________ Emergency Contact

_____________________________________ Phone

Please list any serious medical concerns such as food allergies or Epipen in the space below: ___________________________________________________________________________________ I______________________ grant permission for my son/daughter to participate in Community Service Club and all related activities. _________________________ Parent/Guardian Signature

___________________ Date