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Membership Application for the School Year 2021-2022 Total Due If Paid by August 1, 2021

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Membership Application for the School Year 2021-2022 Total Due If Paid by August 1, 2021 MEMBERSHIP APPLICATION FOR THE SCHOOL YEAR 2021-2022 Mail completed application with applicable fees to VHSL, 1642 State Farm Blvd_, Charlottesvme, VA 22911 Please complete this application and return it with your remittance to the League office by August 1, 2021. If your school division pays your school's membership fee, complete the application and forward it to your school division. Ask them to include your completed application with payment, and send both the application and payment to the League office by August 1, 2021. Partial payment of your membership fee is permitted provided you have received written approval for such payment from the Executive Director, and the complete payment is made on or beforeSeptember 15, 2021 (9-2-2, VHSL Handbook). Your 2021-2022 membership fee is $800 plus $35 foreach varsity activity marked below that your school sponsored during the 2020-2021 school year. Similarly, the insurance premium is also based on your school's total number of participants from the 2020-2021 school year. The insurance formula counts all student participants, with each person counted just once regardless of the number of athletic/academic activities he/she plays. If you are aware that a varsity activity will be added to or deleted from those sponsored during the 2020-2021 school year, you may incorporate those changes into this application. For any new activity, the additional insurance premium due should be based on the number of participants anticipated to be on the team. This completed application serves as your invoice. No further billings will be sent by the VHSL. Q Baseball Q Golf (Girls) 0 Soccer (Girls) 0 Debate 0 Basketball (Boys) 0 Gymnastics (Girls) Q Softball 0 Film Festival 0 Basketball (Girls) 0 Indoor Track (Boys) 0 Swim/Diving (Boys) 0 Forensics 0 Cheerleading 0 Indoor Track (Girls) 0 Swim/Diving (Girls) 0 Scholastic Bowl 0 Cross Country (Boys) 0 Lacrosse (Boys) 0 Tennis (Boys) 0 Student Media (Publications) 0 Cross Country (Girls) 0 Lacrosse (Girls) 0 Tennis (Girls) 0 Theatre Festival 0 Field Hockey 0 Outdoor Track (Boys) D Volleyball (Boys) □ Robotics 0 Football 0 Outdoor Track (Girls) Q Volleyball (Girls) 0 Golf (Boys) 0 Soccer (Boys) 0 Wrestling Number of sponsored activities: 32 x$35 = $1.120.001 Basic Membership Fee: $800.00 League Insurance Premium: (Put# of participants here) + I 678 I Students x $5.50 each = I $3,729.00 I TOTAL DUE IF PAID BY AUGUST 1, 2021: $5,649.00 Enter amount enclosed here + .._I ___ __, Balance Due: $5,649.00 If paid AFTER August 1, 2021, amount due is (10% late fee): ___ _ _ Amount enclosed (if afterAugust 1): LI _____, Balance Due: $5,649.00 Payment for the total amount is due in the League office on or before August 1, 2021, unless you have received an extension from the Executive Director. As principal for Brooke Point High School High School, and with the expressed written authority from my school board, I am applying for membership in the Virginia High School League, Inc., for the school year 2021-2022 Our current classificationis: Class 5 Region Date: District Commonwealth As the representative for this school, I agree to uphold and abide by the League's by-laws, and all rules, regulations and policies, and will instruct and counsel all school personnel to comply with all League rules, regula ions and policies. '2.,I Signed: rn A () M Qa<l/U" Principal Date: �R¥qulik) We certifythat l'ifW\'<.. ror,.,_\- \-li"\i'\ 8cJ',{:o\ High School applies forVHSL membership with the expressed written authority of its school board and with the understanding that the high school subscribes to and agrees to follow the rules of eligibility, and all other rules, regulations and policies of the League. Signed: School Board Chairperson =-,-.,,.---,--,------------(Signature Required) Date Signed: - -----------Superintendent June 3, 2021 =-,(Signature .,,.---,---,-Required) Date □ The Superintendent has given permission forSunday play in emergency situations. FY2022 Membership Application .
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