2012-2013 4-H Eligibility
Verification of Eligibility and/or Request for Absence Form
Name of 4-H Member
Parent Phone #
Primary 4-H Club
Spurs -N- Bridles
In accordance with 4-H policy and TEA Academic Eligiblity Guidelines, I respectfully request:
Academic Eligibility ONLY (my child will not miss any school class time)
Academic Eligiblity and authorization to receive an excused absence from school for the activities I have indicated below.
You may only choose one!
My Child is in the
Choose a Grade
at (Campus Name)
Please check one:
Name of 4-H Activity or Event
If this request is for livestock show, indicate what you will be exhibiting. (i.e. market goat, breeding sheep, horse, heifer)
**We (member and parent/s) understand that follow-up details on the member's participation will be provided to schools as required.
As parent or legal guardian of the aboved mentioned 4-H member I agree that typing my name below serves as my valid signature.
Signature of Parent/Guardian:
Date of Request
This information is requested in accordance with the requirements of Senate Bill 1 and in cooperation with the Texas Education Agency and local public school board policies. This form serves as the official school notification of the 4-H member's intent to participate in one or more extra-currcular activities representing 4-H.