MONTGOMERY COUNTY PUBLIC SCHOOLS

INTRAMURAL/EXTRAMURAL PARENT PERMISSION FORM

CAPOEIRA ANGOLA

INTRAMURAL

Student’s name __________________________ Grade___________

Emergency phone # _____________________________________

I give permission for my child to participate in the after school CAPOEIRA ANGOLA INTRAMURAL at EASTERN

MIDDLE SCHOOL. The program will begin Wednesday, November 19, 2014. This program will be held on Wednesdays

from 2:45-4:00 pm. The sponsor is Mrs. da Cruz(Room 601). More information is included on the back of this form.

If you have any questions feel free to contact her at Kristen_daCruz@mcpsmd.org or call 301-650-6650.

I have indicated below the manner in which my child will be transport home.

___ Activity Bus

___ Walk

___ I will pick up my son/daughter at ___________ (Time)

_____________________________________ Other

(Failure to pick up students on time will result in his/her elimination from the program)

The activity busses will operate on Tuesdays, Wednesdays and Thursdays. The buses will leave the school at 4:00 PM.

____________________________ _________________________

(Signature of Parent/Guardian) (Date)

____________________________ _________________________

(Signature of Parent/Guardian) (Date)

*When the parents are divorced and have legal joint custody, both parents must sign.

Important Medical information about your child ? (severe allergies / bee sting allergy / asthma / heart condition/ etc)

CAPOEIRA ANGOLA

INTRAMURAL

Capoeira Angola cultivates control of emotions, body and mind. It is a rigorous workout that

resembles both martial arts and dance. In class, students will practice the basic movements of

Capoeira Angola both solo and with partners. Students will also learn the instruments and

songs of Capoeira, some of the Portuguese language, Afro-Brazilian history and culture

WEDNESDAYS

Starting NOV 19 See Mrs. da Cruz in room 601 for information