Intramural Registration Form

Two forms are required for participation
1. Registration Form - CLICK TO DOWNLOAD .PDF
2. Permission Slip to Leave the School Grounds - CLICK TO DOWNLOAD .PDF
South Middle School Intramurals 

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Please complete form and return to one of the following locations on or before Monday, October 18th:

Front Office or Mrs. Adamson (Room 313)

Participant’s Name:  _____________________________________________

Grade: ______

Parent Phone Number:________________________

(Number we can reach you at between 2:45pm – 3:45pm):____________________

Parent Email: _________________________________________________


Signature of Parent/Guardian_______________________________________

Date_____________________________ 

Waiver:  In consideration of my child’s participation in this activity, I hereby release and discharge South Middle School and all persons connected with the activity from any and all liability arising from illness, injury and damage my Child may suffer as a result of participation in the activity.  I also understand I am responsible for any cost incurred for medical services or illness, injuries and damages to my child while participating in the activity.


Quarter #2 Activity Choices

Directions:  Rank the following activities in order from 1-5 with 1 being the activity you would like to do the most. Depending on the number of students, we will do our best to get you into your top 3 choices.  You will hopefully get to do 3 activities for 2 weeks each.  You will receive a schedule prior to the start date of session #1 for the entire quarter.



______  Basketball @ Salina Fieldhouse

______  Volleyball @ Salina Fieldhouse

______  Soccer @ Salina Fieldhouse  

______  Dodgeball @ Salina Fieldhouse

______  Bowling @ The Alley

*Ride MUST be able to pick up at this location at 3:45pm



_______  Taekwondo @ SMS

_______  Soccer @ SMS

_______  Board games @ SMS

*Ride MUST be able to pick up at this location at 3:45pm


Name:  ________________________________________