Title: Private School Student Application for Participation in Portland Public Schools Co Curricular Activities
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’s Date of Birth:
Grade in Private School:
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, ___________________
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
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