JJIAA-E1 Student Participation Agreement
EPN/NSBA Code: JJIAA-E1

PRIVATE SCHOOL STUDENT APPLICATION FOR PARTICIPATION
IN
SAD #4 CO-CURRICULAR 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_____________________ (private school name) to provide to SAD #4 upon its request, all information necessary to verify that my son/daughter, ___________________ (student’s 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 SAD #4 policies, administrative procedures, and behavioral, disciplinary, attendance, and other rules that apply to SAD #4 students participating in the co-curricular activity that is the subject of this application.

________________________________________                 ______________________    

Student’s Signature                                                             Date

         

 

Adopted:      January 10, 2012

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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M.S.A.D. #4


I agree to comply with all SAD #4 policies, administrative procedures, and behavioral, disciplinary, attendance, and other rules that apply to SAD #4 students participating in the co-curricular activity that is the subject of this application.

_____________________________________________                        ______________________
Student's Signature                                                                                    Date



Adopted:    January 10, 2012


M.S.A.D. #4