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Permission Slip

Student Name

Parent/Guardian Name

Name of Event

Does the student have permission to attend the event/fieldtrip?
Yes
No

If lunch is not provided does the student have permission to purchase their meal?
Yes
No

Emergency contact name and number

Enter the number below to submit your information.

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Choral Music
DeRuyter Central School
711 Railroad Street
DeRuyter, New York 13052
(315) 852-3400