2nd Annual Victory Day Permission Slip My child _______________________________________________ will be participating on August 12, 2016 for the Victory Day event held at Port Huron High School Memorial stadium from 6:00pm – 8:30pm. A parent must provide transportation and stay with their son or daughter for the duration of the event. X Parent/Guardian’s Signature

Date

(All participants may be videotaped or photographed.) Participants will receive a jersey and a medal! Please indicate your child’s jersey size (limited sizes) and complete the information needed. ______ Adult Medium ______ Adult Large/XL ______Youth Medium

______Adult 2XL

______Youth Large/XL

Address: ________________________________________________ City: ____________________ Zip Code: ________________ Phone Number: _________________ Email: ____________________ Age of participant: _________________ Wheelchair:_______ Allergies:_______ ASL Interpreter:_______ Visual Impairment: _________ Describe:________________________ Any other special medical conditions to be considered? _____________ REGISTRATION MUST BE IN BY Friday, June 24th Space is limited so register early!!! Once we have reached our limit - you will be notified via email and added to the waitlist. We are unable to accept walk-up/onsite registration.

Mail to: Tracey Hopp 3435 N. Burwick Port Huron, MI 48060 [email protected]