Book: I

Section: Instruction

Title: Private School Student Application for Participation in Portland Public Schools Extra Curricular Activites

Code: IHBGC-E2

Status: Active

Adopted: February 3, 2015

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PRIVATE SCHOOL STUDENT APPLICATION FOR PARTICIPATION IN PORTLAND PUBLIC SCHOOLS EXTRACURRICULAR 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. Portland Public Schools will verify eligibility before the student is allowed to try out for the requested activity.

 

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:

 

 

THE FOLLOWING DOCUMENTATION WILL BE REQUIRED FOR VERIFICATION OF ELIGIBILITY TO TRY OUT FOR PARTICIPATION:

 

Evidence that the student currently meets the same behavioral, disciplinary, attendance and other eligibility applicable to all students in Portland Public Schools;

Student’s written agreement to comply with the same behavioral, disciplinary, attendance and other eligibility applicable to all students in Portland Public Schools;

                                                                                                                    

 

Documentation of sports physical (if applicable) and clearance to play;

 

Documentation of immunization presented;

 

Evidence of insurance;

 

Documentation of age eligibility;

 

Documentation of academic standing (grades or other evidence that academic eligibility standards have been met); and

 

Student’s written agreement to abide by the same transportation rules that apply to   regularly enrolled students.

 

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 extra-curricular activity that is the subject of this application

 

________________________________________                     ______________________

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

 

 

I agree to provide to Portland Public Schools documentation of immunization, insurance and sports physical and clearance to play (if applicable) if such information is not maintained at _________________________.

                            (Private School Name)

 

 

_________________________________________                   ______________________

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 extra-curricular activity that is the subject of this application.

 

I also agree to abide by the same transportation rules that apply to all Portland Public Schools participants in this activity.

 

 

________________________________________                     _______       

Student’s Signature                                                                          Date

 

IHBGC-E2 Private Sch Std App for Participation in PPS Extracurr Activities.pdf (11 KB)

 

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