Desktop Schools Popup

Series 640.2.3P - Home School Participation in Cocurricular Activities Registration Form

 

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