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 

Quarter #1 Dates:  September 13th - October 6th

Time:  2:45-3:45 ( Monday and Wednesday) 

Questions: Jana Adamson (785) 309-3929 or

Cost:  Free (cost is the commitment)


Please complete form and return to one of the following locations:

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_______________________________________


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 #1 Activities

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

________ Golf @ Salina Municipal Golf Course (16 participants cap)

 (learn basics, use driving range and putting green (all materials supplied)

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

______  Kickball @ SMS

______  Whiffle Ball @ SMS

Name:  ________________________________________