Policy Details

5137.1 FORM Extracurricular Activities Participation Fee

5137.1

FORM

STUDENTS

LITCHFIELD PUBLIC SCHOOLS

CONFIDENTIAL WAIVER FORM

EXTRACURRICULAR ACTIVITIES PARTICIPATION FEE


DATE: _____/_____/_____

SCHOOL: Center School Intermediate School Litchfield High School

STUDENT NAME(S) (print) GRADE(S) ACTIVITY FEE(S)

______________________________ ____________ ____________________ $_______________

______________________________ ____________ ____________________ $_______________

______________________________ ____________ ____________________ $_______________

______________________________ ____________ ____________________ $_______________


PARENT/GUARDIAN NAME (print): ________________________________________________________

________________________________________________________

Waiver Request: Please describe below the nature of your fee waiver request.

_____ Student(s) receives free or reduced price lunch, the fee is automatically waived.

_____ OTHER – Please describe.

For Office Use Only

Reviewed by: _____________________________________________ Date: _____/_____/_____

Building Principal or Designee

Approved or Denied

Parent or guardians please submit completed form to the appropriate school

building Principal(s) for review and approval process.

Litchfield Public Schools
Form Adopted: September 28, 2004

Download a PDF of this Form

Powered by Finalsite