Policy Manual

For access to the form, click here.

Policy JJIAA-R

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: _______________ 

The Following Documentation Will Be Required Prior  To Administrative Approval For Participation:

Consent to release records

Evidence that the student currently meets the same behavioral, disciplinary,  attendance, academic standing, and other eligibility applicable to all students in  the South Portland School department;

Student’s written agreement to comply with the same behavioral, disciplinary,  attendance, eligibility, and transportation rules applicable to all students in the  South Portland School Department; 

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

Birth certificate. 

Consent To Release Records 

I authorize ______________________ _____________ _______________ to provide to  

Private School Name Phone Number Fax  

____________________ upon its request all information necessary to verify that my  

South Portland School  

son/daughter, __________________________ meets the participation requirements in the  

Student’s Name 

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 South Portland School Department policies, administrative procedures,  and behavioral, disciplinary, attendance and other rules that apply to South Portland students  participating in the co-curricular activity that is the subject of this application.  

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

________________________________________ ___________________________  

Student’s Signature Date  

Administrative Checklist  

_____ Written application received ____________________  

  Date

_____ Student’s written agreement to comply with behavioral, disciplinary, attendance,  transportation, and

other rules applicable to all students in South Portland  

_____ Sports physical (if applicable) performed on ___________; Cleared to play? Yes/No   Date  

_____ Documentation of immunization presented  

_____ Documentation of insurance  

_____ Documentation of age eligibility  

_____ Documentation of academic standing (principals may ask to see grades or other evidence that academic eligibility has been met)

_____ Student has completed tryout (if applicable)  

_____ Student has been selected/not selected for the activity (circle one)  

_____ Student participation in the desired activity is ______ approved ______not approved  

Decision by: ______________ (Name and Title) Date: _____  

Student/parent notified of decision: Date: ______ Method: ________  

Athletic Director/Co-Curricular Advisor notified of the decision: Date:______ Method:________

*Please excuse any formatting errors.