GRISSOM EARRING PERMISSION FORM

 

Student Name:   __________________________________

 

Date:_____________           Marking Period (circle)   1     2     3     4

Physical Education Class Hour: (circle)    1    2    3    4    5    6  

Dear Ms. McLean and/or Mr. Gurney and/or Mr. Rodriguez :

I give my daughter/son permission to keep his/her pierced earrings in for 10 weeks.  I am aware that jewelry is strictly prohibited for safety reasons in Physical Education class.  NO Hoop Earring will be allowed, just post in class.

Therefore, I accept responsibility for any injuries that may occur to my child while wearing earrings in Physical Education class.

Reason for leaving earring in: (circle the reason that applies)

New             Infected              Other:______________________

Location of earring(s): (circle)    Right Ear       Left Ear          Both Ears

Belly Button   Tongue   Eye Brow   Lip    Nose   Other:___________

 

(Parent/Guardian Signature)______________________________________