Cipriano Run Permission Slip

If you child is interested in running in the Cipriano Memorial Please fill this out and let me know.

Dear Parent/Guardian,

Your child has qualified to run in the 5th Annual Robert Cipriano Memorial Cross Country Meet on Saturday, October 15th at Ford Field Park in Dearborn. He/She qualified in their physical education class. All students in grades 4th-8th had the opportunity to qualify for this race. The cost of participation is $2 per student.

4th and 5th grade elementary students will compete in a timed one-mile race and 6th– 8th grade middle school students will compete in a two-mile race. The first student race will begin at 9:00 a.m. with each subsequent race starting at approximately 20 minute intervals for elementary and 25 minute intervals for middle school.

Students and their families are responsible for arranging transportation and supervising their children while they are not competing. Students are to report to the shelter on the north side of the park and check-in with their schools. We will have a brief award ceremony after each race to announce the winning runners and the winning schools. We will all hope for good weather but the rain will not stop us from running. In the event of severe weather (lightning, thunder, heavy rains and/or winds) we may be forced to reschedule the event. In the event of severe weather look to the Dearborn Athletic Blog for further information Please make sure they are dressed for the weather. Ford Field is located at Cherry Hill and Brady. We hope to see you there!

1 Mile Race

Staff Run 8:30

2 Mile Run

6th -8th grade boys 9:00

6th – 8th grade girls 9:25

1 Mile Run

4th grade boys 9:50

4th grade girls 10:10

5th grade boys 10:30

5th grade girls 10:50


Please fill out and give this bottom portion to your child’s physical education teacher. Keep the top portion for your information.

I’m happy to give permission for my child, (name)__________________________ in Mrs. Masiarczyk’s physical education class to participate in the 5th Annual Robert Cipriano CC Meet!

I have included the $2 participation fee.____________

I understand that the meet will be held on Saturday, October 15th at Ford Field, Dearborn. I also understand that I am responsible for arranging transportation to and from the meet and that I am responsible for the supervision of my child at the meet. Teachers/Staff will not be responsible for the supervision of any children. I also understand that I hereby release the Dearborn Public Schools, its employees and agents from any and all claims for liability which might arise from or in connection with this activity.
Parent signature:____________________________ Date:_______ Contact number_______________

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