SKATE PERMISSION SLIP

Dear Parent or Guardian:

Beginning on Feb. 28, 2011, our physical education classes will be participating in an in-house skating program. The skates will be
delivered directly to the school and used inside our gymnasium. This equipment is specifically intended for indoor use and will not
damage our floor.
This skating unit is being implemented because of its emphasis as a “Lifetime Activity". Skating provides a variety of benefits, which
include balance, coordination, motor skills, and a top rated cardio-respiratory workout. Students will also learn basic skating skills such
as starting, stopping, forward skating, backward skating, cornering, and a number of safety tips for being a smart skater. All safety
gear is provided.

The fee for this unit will be $6.00 for quad skates and $9.00 for inline skates per student. The fee includes delivery and pickup
of the equipment as well as use of the skates for 2 weeks of skating. All students must wear helmets & wrist guards at all times.

Please have your child return the bottom portion of this permission slip with the fee no later than Fri. Feb. 18th.

Skatetime® is proud to announce a partnership with USA Roller Sports (USARS) to endorse our services and skating programs.
USA Roller Sports is the National Governing body of roller sports, whose goals are to promote, train and compete in roller sports. After
months of research and development, it has been determined that our skating programs are consistent with entry-level training
performed by USARS Coaches. In other words, students participating in Skatetime School Programs® have the prerequisites to
pursue and excel in their choice of roller sports. We have integrated additional information into our lesson plans and overall curriculum.
This program, which has been named !Future Stars." With USARS involvement as the NGB under the United States Olympic
Committee, it brings additional support and recognition to roller sports. Our intent is to provide educators, additional tools to give your
students the opportunity to move to the next level. Skatetime® and USARS will provide your students a certificate of completion as
well as a method of seeking out a Certified USARS Coach in the discipline of choice. We are committed to our sport, and as always to
the future fitness and wellness of the children of the world. Kids are hungry for information, and our ability to channel activities that
are consistent with discipline, wellness, patriotism and respect are keys in molding of generations to come.
Logon to for more information about getting your child involved in “Future
      We can also be contacted Toll Free at 888.207.5283

In consideration of the permission granted I hereby grant permission for the person named herein to participate in the program
described and associated activities sponsored by the Goochland County Public Schools. I further release Goochland County,
Goochland County Public Schools, its agents, employees, and volunteers from all actions, damages, claims, or demands and all
liability, which might be incurred during the conduct of this activity.
I further authorize the School officials to take the proper steps to provide medical attention should participant be injured while
participating or being transferred to or from any School sponsored activity and I hold said officials and the Goochland County
Public Schools harmless thereof.
I acknowledge the risk and responsibilities involved in this activity. I have read this release and understand all its term and
execute it voluntarily and with full knowledge of its significance.

Activity: SKATETIME School Program (in-house skating program), beginning Feb. 28, 2011 for a 2 week school period.

Name of Student Participant: __________________________________________________

My child's shoe size is__________        Circle [ Girl ][ Boy ]       Gym Teacher: ____________________________

Quad $_________ Inline $_________ Class Period: Day ____ Block: ____
Please make checks payable to: Goochland Middle School

Signature of Participant _________________________________________________________________

Signature of Parent/Guardian _____________________________________________________________
If participant is under 18 as of date of activity.

I wish to donate $______ so that a child who is unable to pay may also skate.

Return permission slip no later than Friday, Feb. 18th. We can make arrangements about payment at
a later date if needed. (Please talk with your child’s gym teacher.)

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