Athletic Eligibility For High School Students - The School District Of Palm Beach County
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3THE SCHOOL DISTRICT OF PALM BEACH COUNTY
Athletic Eligibility for High School Students
Parents, in order for your son or daughter to be eligible to participate in athletics at his/her high school during the upcoming
school year, you and your son or daughter must complete this form and sign where indicated. Make sure you read each page
carefully before signing! A parent or the student (if an adult or emancipated) needs to sign papers in front of a notary. We
cannot notarize any papers if they come to us already signed.
Student's Full Name (first, middle initial, last)
Student ID #
Today's Date
Sex
Age
Current Grade
School Year
Date of Birth
Parent/Legal Guardian
Student's Address (street, apt. #, city, state, zip code)
Telephone #
First School Attended This Year
School Attended Last Year
Name of Emergency Contact
Relationship to Student
Emergency Contact Address (street, apt. #, city, state, zip code)
Emergency Home Telephone #
Emergency Work Phone #
Student's Personal Physician
Physician Telephone #
List Sports
PROOF OF INSURANCE FOR STUDENT
Name of Policy Holder (Insurance Policy that covers student)
Policy Holder Relationship to Student
Policy Holder Place of Employment
Name of Medical Insurance Company (Insurance Policy that covers student)
Insurance Policy #
ATHLETIC ELIGIBILITY REQUIREMENTS FOR HIGH SCHOOL STUDENTS
TRANSFER STUDENTS AND NEW STUDENTS must have transcripts on file before an athlete is eligible to participate.
ALL STUDENT OBLIGATIONS must be met before participation in athletics/activities is allowed.
ALL SECTIONS OF THIS FORM must be filled out, signed & MUST BE ON FILE in Athletic Director's Office ten days prior to the
first contest.
ALL STUDENTS MUST HAVE a Birth Certificate* on file in the Athletic Office.
ALL STUDENTS will be responsible for a portion of their athletic insurance.
ALL FRESHMEN must be academically promoted.
A STUDENT SHALL BE ELIGIBLE for no more than four (4) consecutive academic years from the date he/she first enrolls in the
ninth (9th) grade.
A STUDENT SHALL BE ELIGIBLE until reaching the age nineteen (19) and nine months.
A STUDENT ENTERING the 9th through 12th grades must maintain a 2.0 cumulative grade point average in all courses taken
that are required for graduation to be academically eligible to participate in interscholastic athletic competition. If student in the
ninth or 10th grade falls below the 2.0 cumulative grade point average requirement, the student will be allowed to participate
on a semester-by-semester basis if the student (a) earns a 2.0 grade point average on courses taken in the previous semester
alone, (b) signs an academic performance contract with the school, and (c) attends summer school, if offered. Once, however,
the student enters the 11th grade he or she must have and maintain from that point forward the 2.0 cumulative grade point
average to be eligible. Student must maintain satisfactory conduct. (S.B. Policy 5.60)
* If specific documentation requested is not available, contact the athletic director for further instruction.
School
Athletic Director
Telephone #
PBSD 1588 HS (Rev. 07/19/2010)
ORIGINAL - School Athletic Office
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