Series 640.2.3P - Home School Participation in Cocurricular Activities Registration Form
Adopted: July 1999
Revised: June 2001
TO HOME SCHOOL: If one of your students would like to participate in a public school
cocurricular activity, as described in Administrative Regulation 640.2.3AR, Home School
Student Participation in Cocurricular Activities, complete this registration form and return it to:
Director of Community Education, 15180 Canada Avenue, Rosemount, MN 55068.
GENERAL INFORMATION – Please print
____________________________________________________________ ______________________
Student name Date of birth
____________________________________________________________________________________
Parent/Guardian name(s)
_______________________________________________________ ____________________________
Address City/Zip
Home phone Work phone
District 196 school attendance area
I have read Administrative Regulation 640.2.3AR, Home School Student Participation in Cocurricular Activities: ❏ Yes ❏ No
____________________________________________________________ _____________
Signature of Parent or Guardian (or student if 18 years of age or older) Date
DISTRICT 196 COCURRICULAR REQUEST(S)
School Year: 20 _______ – _______ Grade _________ School ________________________
Activity ________________________________________________ ❏ 1st Trimester or Quarter
Activity ________________________________________________ ❏ 2nd Trimester or Quarter
Activity ________________________________________________ ❏ 3rd Trimester or Quarter
Activity ________________________________________________ ❏ 4th Quarter
DISTRICT USE ONLY
According to our records, the student listed above is a home school student in compliance with the Minnesota Compulsory Instruction Law and resides in District 196.
____________________________________________________________ _____________
Signature of Director of Community Education Date
c: Home School School Principal
Procedure/640.2.3P/6-18-01