Richland School District Two

MIDDLE SCHOOL ATHLETIC ELIGIBILITY FORM

FOR ZONED HIGH SCHOOL

Ø    This form must be completed before any seventh or eight grade student can compete in a sport at the high school for which they are zoned to attend.

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{PLEASE PRINT}

STUDENT’S FULL NAME:_____________________________Date______________

Student’s Permanent Address: ___________________________________________

Current Middle School Attending:__________________________________________

Current Grade:_____________

School Year: ______________

High School at which you are currently zoned to attend:_________________________

Name of Sport(s) requesting to play:_____________________________________________

**Please note that if false information is given related to the above permanent address/high school student is zoned for, the student will be ineligible for one year.

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Student’s Signature                                               Parent/Guardian’s Signature

Ø      NOTE: A proof of residency (recent light or water bill, etc.) must be attached to this form.

DO NOT WRITE BELOW THE PERFORATED LINE

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(FOR OFFICE USE ONLY)

                  Approved_______________                          Not Approved________________

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Athletic Director Signature                                                Date

*THIS FORM WILL BE KEPT ON FILE IN THE OFFICE OF THE DIRECTOR OF ATHLETICS.