JJIAA-E2 Private School Student Application for Participation in SAD #4 Interscholastic Athletic Activities
NEPN/NSBA Code: JJIAA-E2 

PRIVATE SCHOOL STUDENT APPLICATION FOR PARTICIPATION IN SAD #4 INTERSCHOLASTIC ATHLETIC 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. SAD #4 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 SAD #4; 
  • Student’s written agreement to comply with the same behavioral, disciplinary, attendance, and other eligibility applicable to all students in SAD #4; 
  • Documentation of sports physical 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 __________________ (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 interscholastic athletic activity that is the subject of this application.

I agree to provide to SAD #4 documentation of immunization, insurance, and sports physical and clearance to play 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 SAD #4 policies, administrative procedures, and behavioral, disciplinary, attendance and other rules that apply to SAD #4 students participating in the interscholastic athletic activity that is the subject of this application.

I also agree to abide by the same transportation rules that apply to all SAD #4 participants in this activity.

________________________________________ ______________________

Student’s Signature                                                 Date

M.S.A.D. #4