Georgia Department of Education

Division of Standards and Fiscal Services

Participation Roster

For Competitive Interscholastic Activities (Grades 9-12)

_________________________________ ____ ___________

Activity Coach/Sponsor

____________________

Date of First Conditioning/Tryout or practice Date of Last Practice or Activity

Coosa High School _________ ___________ ___9-12____ _

School Code Grades

Floyd_County___________________________ ___________ __2004-2005 _

System Code School Year

__________________________ __________________________

Signature of Principal Signature of Coach/Sponsor

Name of Participants

Grade

Date Student Entered 9th Grade

First Date of Athletic Conditioning, Tryout, or Practice

Date of Physical Exam

I certify that the information for the students listed on this form has been taken from the student's permanent school records and meets all eligibility requirements for interscholastic competition under the rules and regulations as stated in the current edition of the GHSA Constitution and By-Laws. I understand that incorrect information will severely penalize my school and students.

SIGNED________________________________________________________ ________________________________________

(Superintendent or Principal or Assistant Principal-No Stanps) Report Preparer