# JJIAB-E4 --DELETED-- VERIFICATION OF PRIVATE SCHOOL STUDENTS - ELIGIBILITY FOR PARTICIPATION IN CAPE ELIZABETH EXTRACURRICULAR ACTIVITIES
## REMOVAL FROM POLICY MANUAL: MAY 13, 2025
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 EXTRACURRICULAR 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’s written agreement to abide by same transportation as regularly enrolled students \_\_\_\_\_\_\_\_\_\_\_\_\_ (Date)
Sports physical (if applicable) performed on \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ (Date)
Cleared to play \_\_\_\_\_\_ yes \_\_\_\_\_\_ no
Tryout (if applicable) \_\_\_\_\_\_ yes \_\_\_\_\_\_ no
Selected (if applicable) \_\_\_\_\_\_ yes \_\_\_\_\_\_ no
Documentation:
Immunization \_\_\_\_\_\_ yes \_\_\_\_\_\_ no
Insurance \_\_\_\_\_\_ yes \_\_\_\_\_\_ no
Age eligibility \_\_\_\_\_\_ yes \_\_\_\_\_\_ no
Academic standing (principal may ask to see grades or other evidence that academic
eligibility has been met) \_\_\_\_\_\_ yes \_\_\_\_\_\_ no
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