Dexter Mosley Act Participation Declaration

• Student Name

  Student Name * First Last
• Parent Name

  Parent Name * First Last
• Permanent Address, City, Zip *
• Contact Email *
• Contact Phone

  Contact Phone * - ### - ### ####
• BCSS School of Residence: *
  Bear Creek Middle School Haymon-Morris Middle School Russell Middle School Westside Middle School Apalachee High School Winder-Barrow High School
• School/Homeschool Program Currently Enrolled: *
• Grade Level *
• Sports/Activities *
• ENROLLMENT ACKNOWLEDGEMENT *
  ENROLLMENT ACKNOWLEDGEMENT

  I understand this declaration must be submitted to the school of residence 30 days prior to semester of participation. I understand my student must maintain enrollment in one course per semester to remain eligible for extra-curricular and interscholastic athletics. I understand my student must adhere to attendance requirements per BCSS Student/Parent Handbook. I understand my student must meet the same eligibility requirements as full-time BCSS students (accumulated units, units passed the previous semester, etc.). I understand my student must reside in the attendance area of his/her custodial parent’s primary residence. I understand my student must attain approval to participate at Barrow Arts and Sciences Academy (BCSS Choice High School) OR must participate in the school of residence. I understand my student must follow the BCSS Code of Conduct. I understand withdrawal of my student from BCSS to homeschool full-time will result in the loss of eligibility for one calendar year. I understand my student is ineligible to participate in the BCSS graduation. I understand my student must attain Pre-Participation Physical Evaluation (linked above). I understand my student must be enrolled in the Barrow County School System (BCSS).
• Electronic Signature *