Book: I

Section: Instruction

Title: Private School Student Application for Participation in Portland Public Schools Co Curricular Activities

Code: IHBGC-E1

Status: Active

Adopted: February 3, 2015

PRIVATE SCHOOL STUDENT APPLICATION FOR PARTICIPATION IN PORTLAND PUBLIC SCHOOLS COCURRICULAR ACTIVITIES

The parent (or student if 18 years of age or older) must submit a separate application for each activity in which participation is desired. 

STUDENT INFORMATION

Student’s Name:

Student’s Date of Birth:

Grade in Private School:    

Student’s Address:  

Phone Number:

Parent/Guardian’s Name:

Private School Name:

Private School Address:

Private School Phone Number:

Private School Principal/Head’s Name:

Student is Applying for Participation in the Following Activity:

VERIFICATION OF ELIGIBILITY

I authorize ________________________ to provide to Portland Public Schools upon its

                        (Private School Name)

request all information necessary to verify that my son/daughter, ___________________

                                                                                                                        (Student Name)

meets the eligibility requirements for participation in the co-curricular activity that is the subject of this application

________________________________________                     ______________________

Parent’s Signature (or Student’s, if 18 or older)                          Date

STUDENT PARTICIPATION AGREEMENT

I agree to comply with all Portland Public Schools policies, administrative procedures, and behavioral, disciplinary, attendance and other rules that apply to Portland Public Schools students participating in the co-curricular activity that is the subject of this application.

________________________________________                     _______       

Student’s Signature                                                                          Date

IHBGC-E1 Private Sch Std App for Participation in PPS CoCurr Activities.pdf (9 KB)