THE SCHOOL DISTRICT OF PALM BEACH COUNTY
Athletic Eligibility for High School Students
Parents, in order for your Child/Ward to be eligible to participate in athletics at his/her high school during the upcoming
school year, you 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) will need to sign the 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 #
INTERSCHOLASTIC ELIGIBILITY RESIDENCE AFFIDAVIT
I live with (check one) both parents Mother Only Father Only Guardian Other
Relationship to other I have lived with the person(s) stated above since
If the options presented below do not adequately describe your residence situation, attach a note of explanation.
I live in the assigned attendance area for this school. I have been accepted into a Choice Program.
I am attending this school on an approved student reassignment (reassignment requires approval by the Reassignment
Specialist)
I have been assigned to this school by the Department of Exceptional Student Education.
School Athletic Director Telephone #
PBSD 1588 HS (Rev. 3/12/2018) ORIGINAL - School Athletic Office Page 1 of 4
ATHLETIC ELIGIBILITY REQUIREMENTS FOR HIGH SCHOOL STUDENTS
Per the FHSAA Handbook/Operational Bylaw, Article 9
Parent Initial
• 9.1.1.1 Participation in Interscholastic Athletics a Privilege. Participation in interscholastic athletic programs by a student is a
privilege, not a right. Students who participate are required to meet the requirements established in state law, FHSAA
_______ regulations, and by their respective schools
• 9.1.1.1 Local Rules May Be More Stringent. Schools and/or school districts may adopt more stringent rules for the students
_______ under their supervision. No school, or school district, however, may adopt rules that are less stringent than those of the
FHSAA
• 9.1.2.2 Falsification of Information. A student and/or parent/legal guardian appointed by a court of competent jurisdiction
falsifies information to gain eligibility shall be declared ineligible to represent any member school for a period of one year from
_______ the date of discovery
• 9.1.2.3 Eligibility of Recruited Students. A student may be declared ineligible based on violation of recruiting rules if: (a) The
student of parent/legal guardian appointed by a court of competent jurisdiction has falsified any enrollment or eligibility
document; or (b) The student or parent/legal guardian appointed by a court of competent jurisdiction accepted any benefit or
_______ any promise of benefit if such benefit is not generally available to the school’s students or family members; or (c) The benefit or
promise of benefit is based in any way on athletic interest, potential, or performance
• 9.2.1 Student May Participate at School he/she First Attends Each School Year. A student must attend school and is
immediately eligible to participate in the interscholastic athletic programs sponsored by the school he/she attends each school
year, which is either: (a) The school where the student first attends classes (i.e. establishes school residency); or (b) The
school where the student first participates in athletic activities on or after the official start date of that sport season before he/
she attends classes at any school (i.e. establishes school residency); or (c) The school the student transfers to after previously
_______ attending another school (Reference Bylaw 9.3.2)
• 9.3.4 Ineligible Student Cannot Transfer to Become Eligible. A transfer student who is deemed ineligible for a period of time
cannot transfer schools and become eligible. Attending a new school at the beginning of the school year does not decrease or
_______
eliminate the period of ineligibility
• 9.4.1 2.0 GPA Required for Academic Eligibility. A high school student must have a cumulative 2.0 grade point average on a
4.0 unweighted scale, or its equivalent, at the conclusion of each semester to be academically eligible during the next
_______ semester. Final grades previously earned by the student from another school shall not be converted using the scale in Bylaw
9.4.2
• 9.4.1.3 Attendance During Previous Two Consecutive Semesters Required. A student cannot be academically eligible if he/
_______ she has not attended school and received grades for all courses taken during the previous two consecutive semesters
• 9.4.1.9 Student Not Eligible for One Full Semester if Transcript Cannot be Obtained. A student whose former school cannot
or will not provide an official sealed transcript will not be eligible in the new school until he/she has been in attendance for one
full semester and has established a cumulative GPA. The school must submit a written report to the FHSAA Office that
includes the student’s name, date of first attendance in the school, and the beginning and ending dates of the previous
_______
semester
• 9.5.1 High School Student Has Four Years of Eligibility. A student is limited to four consecutive school years of eligibility
beginning with school year he/she begins ninth grade for the first time. This does not imply that the student has four years of
_______ participation. After four consecutive school years, the student is permanently ineligible
_______ • 9.6.1 High School Age Limit. A student who reaches the age of 19 prior to September 1st shall become permanently ineligible
I/WE HAVE READ, AND HAVE INITIALED, EACH FHSAA ELIGIBILITY REQUIREMENT FOR HIGH SCHOOL
STUDENTS AND ACKNOWLEDGE THAT OUR SON/DAUGHTER/WARD MUST MEET FHSAA STANDARDS IN
ORDER TO BE CONSIDERED ELIGIBLE FOR INTERSCHOLASTIC ATHLETICS
STATE OF FLORIDA
COUNTY OF __________________________________
Sworn to or affirmed and subscribed before me this ______ day of ______, _____, by ______________________________________.
(parent/guardian or adult/emancipated student)
Personally Known _________ OR Produced Identification _____ Signature of Notary Public - State of Florida
Type of Identification Produced _________________________________________________
PBSD 1588 HS (Rev. 3/12/2018) ORIGINAL - School Athletic Office Page 2 of 4
CONSENT AND RELEASE OF LIABILITY CERTIFICATE - READ CAREFULLY BEFORE SIGNING
I (the student) and we (the parent[s]/legal guardian[s]) have read the (condensed) Florida High School Athletic
Association (FHSAA) Eligibility Rules and understand that they are a synopsis of the FHSAA Bylaws. I/we also
understand that a complete copy of the FHSAA Bylaws is available to me/us to review at my (the student's) school's
administrative office. We know of no reason why I (the student) am not eligible to represent my school in athletic
competition. If accepted as a representative, we agree to follow the rules of my school and the FHSAA and to abide by
their decisions. I/we know that participation is a privilege. I/we have been informed and know of the risks involved in
athletic participation, understand that serious injury, and even death, is possible in such participation and choose to
accept such risks. I (the student) voluntarily accept any and all responsibility for my own safety and welfare while
participating in athletics, with full understanding of the risks involved. I/we hold harmless and release the student's
school, the school district's employees and agents, the schools against which it competes, the Palm Beach County
School District and the contest officials, the National Federation of State High School Associations, (NFHS) and the
FHSAA of any and all responsibility and liability for any injury or claim resulting from such athletic participation, and agree
to take no legal action against any of the above-referenced entities because of any accident or mishap involving the
student's athletic participation. I/we further authorize EMERGENCY MEDICAL TREATMENT for myself/our child/ward
should the need arise for such treatment while I am/my child/ward is under the supervision of the school. In
consideration for being allowed to participate in Interscholastic Athletic programs, I/we, for my/our heirs,
executors and administrators, release and forever discharge THE SCHOOL BOARD OF PALM BEACH COUNTY,
FLORIDA, its agents, representatives and employees of all liability, claims, actions, damages, costs or expenses
which I/we may have against them arising out of or in any way connected with my (the student's) participation in
an Interscholastic Athletic program, including travel associated with the Athletic Program. I/we understand that
this waiver includes any claims based on negligence, action or inaction of any of the above named entities and
persons. I/we hereby give permission for the school or District to use the student's photograph, video image, writing,
voice recording, name, grade level, school name, description of participation and statistics in officially recognized
activities and sports, weight and height as a member of an athletic team, dates of attendance, diplomas and awards
received, date and place of birth and most recent previous school attended, in newspapers, school productions, web
sites, etc. and/or similar school or District-sponsored publications or in school or District-approved news media
interviews, videos, articles and photographs. The released parties, however, are under no obligation to exercise said
rights herein. I/we hereby give consent for my/our child/ward to participate in the following interscholastic sports that I/we
have NOT MARKED OUT. Sports: Baseball, Basketball, Bowling, Competitive Cheerleading, Cross Country, 11-Man
Tackle Football, Flag Football, Golf, Lacrosse, Soccer, Fast-Pitch Softball, Swimming & Diving, Tennis, Track & Field,
Volleyball, Water Polo, Weight-lifting, Wrestling.
I/we understand that participation may necessitate an early dismissal from classes. I/We consent to the
disclosure, by my/our child's/ward's school, to the FHSAA, upon its request, of all detailed (athletic or otherwise)
financial, scholastic and attendance records of such school concerning my/our child/ward.
PBSD 1588 HS (Rev. 3/12/2018) ORIGINAL - School Athletic Office Page 3 of 4
ADDENDUM TO CONSENT AND RELEASE
This form was created to comply with the provisions of Fla. Stat. § 744.301 as it relates to the enforceability of a waiver or release
executed by a parent/guardian on behalf of their child/ward. This addendum applies to the parent/guardian waiving the right of a child/
ward in advance of the child's/ward's participation in an activity.
NOTICE TO THE MINOR CHILD'S NATURAL GUARDIAN
READ THIS FORM COMPLETELY AND CAREFULLY. YOU ARE AGREEING TO
LET YOUR MINOR CHILD ENGAGE IN A POTENTIALLY DANGEROUS ACTIVITY.
YOU ARE AGREEING THAT EVEN IF THE SCHOOL BOARD OF PALM BEACH
COUNTY, FLORIDA USES REASONABLE CARE IN PROVIDING THIS ACTIVITY,
THERE IS A CHANCE YOUR CHILD MAY BE SERIOUSLY INJURED OR KILLED
BY PARTICIPATING IN THIS ACTIVITY BECAUSE THERE ARE CERTAIN
DANGERS INHERENT IN THE ACTIVITY WHICH CANNOT BE AVOIDED OR
ELIMINATED. BY SIGNING THIS FORM YOU ARE GIVING UP YOUR CHILD'S
RIGHT AND YOUR RIGHT TO RECOVER FROM THE SCHOOL BOARD OF PALM
BEACH COUNTY, FLORIDA, IN A LAWSUIT FOR ANY PERSONAL INJURY,
INCLUDING DEATH, TO YOUR CHILD OR ANY PROPERTY DAMAGE THAT
RESULTS FROM THE RISKS THAT ARE A NATURAL PART OF THE ACTIVITY.
YOU HAVE A RIGHT TO REFUSE TO SIGN THIS FORM, AND THE SCHOOL
BOARD OF PALM BEACH COUNTY, FLORIDA HAS THE RIGHT TO REFUSE TO
LET YOUR CHILD PARTICIPATE IF YOU DO NOT SIGN THIS FORM.
I/WE HAVE READ THIS CAREFULLY, UNDERSTAND IT, AND KNOW IT CONTAINS A RELEASE
Where appropriate both parent(s)/legal guardian(s) should sign.
Signature of Student Date Signature of Parent/Legal Guardian Date
Signature of Parent/Legal Guardian Date
STATE OF FLORIDA
COUNTY OF __________________________________
Sworn to or affirmed and subscribed before me this ______ day of ______, _____, by ______________________________________.
(parent/guardian or adult/emancipated student)
Personally Known _________ OR Produced Identification _____ Signature of Notary Public - State of Florida
Type of Identification Produced _________________________________________________
PBSD 1588 HS (Rev. 3/12/2018) ORIGINAL - School Athletic Office Page 4 of 4
