JJIAB-E3 (FORM) - VERIFICATION OF PRIVATE SCHOOL STUDENTS - ELIGIBILITY FOR PARTICIPATION IN CAPE ELIZABETH CO-CURRICULAR ACTIVITIES A separate application must be received for each activity in which participation is desired. This form is used to verify eligibility and to approve/deny participation. 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: FOR CO-CURRICULAR ACTIVITIES Written application received ______________ (Date) Student's written agreement to comply with behavioral, disciplinary, attendance and other rules applicable to all students in Cape Elizabeth Schools received ______________ (Date) Student participation in the desired activity is ______ approved ______ not approved. Decision by_______________________________________________________ (Name & Title) Student/parent notified of decision: _______________ (Date) _______________ (Method) Adopted: December 13, 2011