5th Grade Social Consent Form
The Jefferson PTA's 5th Grade Committee would like to invite your child(ren) to the 5th Grade Social. The event will be held on April 29, 2022 from 6:30 - 8:00pm at the DeHart Community Center located at 120 Burnett Ave. Maplewood.

Please complete this form by April 25, 2022 so we know how many children we can expect at the event.
Consistent with the district allergy policy, all snacks served at the event will have ingredient labels for students to review. To view the policy, visit: https://www.straussesmay.com/seportal/Public/DistrictRegulation.aspx?Regulationid=5331&id=ec383bd3811249869634a09869e432ef.

If you have any questions, please contact us at 5thgradeprojects@jefferson-pta.org.

(If you have more than one child in the 5th grade at Jefferson, please complete the form for each child.)

Thank you!

* Required
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Student First Name: *
Student Last Name: *
Parent/Guardian Name: *
Emergency Contact Number *
My child will be attending the 5th Grade Social. *
Child's Homeroom Teacher *
I grant my child permission to advocate for themself when selecting snacks. This includes reading all ingredient labels to determine possible allergens. *
I am responsible for transporting or arranging transportation for my child to and from this off-campus event at the DeHart Community Center located at 120 Burnett Ave Maplewood. *
List of people authorized to pick up my child. *
Any questions? Thank you!
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