Exhibit IDE(1)-E(2): Competitive Interscholastic Activities, Grades 9-12 - 2

IDE(1)-E(2) · Exhibit · Adopted 04/13/2018

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APPLICATION FOR PARTICIPATION IN “HOME” SCHOOL SPORTS PROGRAM
        The student and parent are required to complete and sign this form every year that a student wishes to participate in
        DCSD athletics at the “HOME” school. This form must be kept on file with the school and is subject to inspection by
        the Department of Athletics.

SECTION A      SPORT                                                                          BIRTHDATE
 Student
 Personal      STUDENT NAME                                                                   AGE
  Data
               EMAIL ADDRESS                                                                  GRADE

               HOME ADDRESS



               HOME SCHOOL                                                  CURRENT SCHOOL

               PHONE #                                                                        GENDER

               DATE OF LAST                                                         DATE OF
               PHYSICAL                                                             APPLICATION

SECTION B      PARENT NAME                                                                    PHONE #
  Parent/
 Guardian      HOME ADDRESS
   Data


               ARE YOU THE LEGAL GUARDIAN OF THE STUDENT?

               EMERGENCY CONTACT                                                     PHONE#



SECTION C      Attach a brief statement explaining why this request is being made.
  Written
 Request

        By submitting this form, I hereby request permission for the above named applicant/student to
        participate in the sports program at his/her HOME school. I understand that is it my responsibility
        to provide transportation to any practices and/or competitions held at the school and that the
        District will not be responsible for transporting the applicant back to his/her current school. I
        understand that the applicant must meet all athletic eligibility requirements of the Georgia High
        School Association, DeKalb County School District and the School. I further understand that this
        application for participation does not assure selection for the team or the sport.
        Parent/Guardian Signature ____________________________ Date _____________________

        Student Signature ___________________________________ Date _____________________


                                                    FFOR DISTRICT USE ONLY
   CURRENT SCHOOL ADMINISTRATOR/ATHLETIC DIRECTOR SIGNATURE _______________________________________
   RECEIVING SCHOOL ADMINISTRATOR/ATHLETIC DIRECTOR SIGNATURE______________________________________
   EXECUTIVE DIRECTOR OF ATHLETICS SIGNATURE _______________________________________________________
   DEPARTMENT OF ATHLETICS FILE DATE ____________________________________________

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