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JJIAA-E1 PRIVATE SCHOOL STUDENT APPLICATION FOR PARTICIPATION IN MSAD#11 CO-CURRICULAR ACTIVITIES
PRIVATE SCHOOL STUDENT APPLICATION FOR PARTICIPATION IN MSAD #11
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/Headmaster’s Name:
Student is Applying for Participation in the Following Activity: _______________________
VERIFICATION OF ELIGIBILITY
I authorize __________________________________________________________to provide to
Private School Name
MSAD #11 upon its request all information necessary to verify that my son/daughter,
_____________________________________________________ meets the eligibility Student's Name
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 MSAD #11 policies, administrative procedures, and behavioral, disciplinary, attendance and other rules that apply to MSAD #11 students participating in the co-curricular activity that is the subject of this application.
Student's Signature Date
Adopted: January 5, 2012