<p> Revised 11/1/2013 LOS ANGELES UNIFIED SCHOOL DISTRICT Beyond the Bell Branch APPLICATION FOR CONDUCTING INTERSCHOLASTIC COMPETITION FOR ELEMENTARY AND MIDDLE SCHOOL STUDENTS</p><p>The Superintendent of Schools may consider requests to waive Board Rules 2401 and 2402 which restrict interschool competition for elementary and middle school students. Groups may apply to conduct interschool competition by completing the information on this form and following the steps listed below. Once this application is received by Beyond the Bell Branch, a determination by the Superintendent of Schools (or designee) will evaluate the request, and notify the group as to whether or not the request has been approved. </p><p>REQUESTOR/AGENCY (NAME OF GROUP/ORGANIZATION)</p><p>BRIEF DESCRIPTION OF ACTIVITY</p><p>ADDRESS</p><p>TELEPHONE NUMBER(S)</p><p>NAME OF SCHOOL(S) PARTICIPATING IN THE INTERSCHOOL COMPETITION</p><p>APPROVAL OF THE PRINCIPAL/ADMINISTRATOR OF EACH SITE PARTICIPATING IN THE INTERSCHOOL COMPETITION IS REQUIRED (Attach additional pages if necessary OR a separate application may be used for each site, if preferred). </p><p>NAME OF SCHOOL PRINCIPAL’S NAME/SIGNATURE DATE SIGNED 1. 2. 3. 4. 5. </p><p>DATE(S)/TIME(S) INTERSCHOOL COMPETITION WILL BE CONDUCTED (attach additional pages if necessary)</p><p>Group/Organization must show proof of insurance to District specification/standard. Indicate “attached” if copy is attached to the application or indicate “on-file” if copy is with the District per existing contract or lease. Attached On-file</p><p>Attach a sample of the permission form for parents/guardians allowing their child(ren) to participate in the Interschool Competition. Revised 11/1/2013 If applicable, attach a sample of the transportation form for parent/guardians allowing their child(ren) to be transported while taking part in the Interschool Competition (Note: Groups must comply with the Los Angeles Unified School District’s “unauthorized/non-sponsored trip” procedures as detailed in the Field Trip Handbook and Revised Procedures document (click here to view REF-2111.0 Field Trips Handbook and Revised Procedures). </p><p>Designate the type of transportation being used. LAUSD School Bus Charter/Private School Bus Municipal Bus</p><p>Private Van Private Automobile</p><p>Obtain an “unauthorized/non-sponsored” letter from the principal/administrator of the school(s) where students will be traveling to a different site (see REF-2111.0 above). NOTE: Provide copies of letter once obtained.</p><p>Attach a list of age appropriate rules for the sport or activity being conducted during the Interschool Competition event(s). </p><p>By the requestor’s signature on this application, s/he is affirming that:  All participants will adhere to applicable District rules and policies for use of District property;  All employees or volunteers are cleared to work in a manner authorized by the DOJ. o Agency maintains current Fingerprint and Criminal Background Check Certification form (click here to view BUL-3872.0 Fingerprinting and Criminal Background Compliance for Contractors) certifying that all employees/volunteers who may come into contact with students have not been convicted of a serious or violent felony as defined in Education Code 45122.1; o Agency maintains “subsequent arrest notification” with the DOJ. Note: Contractors are responsible for notifying LAUSD/Office of Risk Management and Insurance Services and advising of any change in the status of their employees/volunteers;  All staff (paid or volunteer) working with students are certified in First Aid and CPR and that basic first aid supplies are available at each site where activities are being conducted;  Accidents or injuries will be reported immediately to the Beyond the Bell Branch;  Adults will not use or enter bathrooms intended for students. They will be instructed to use bathrooms designated for adults only;  All changes to the scheduled activities will be communicated to the Beyond the Bell Branch at least 24 hours in advance; and  The areas used during the events are maintained and returned to the same or better condition.</p><p>NAME OF REQUESTOR (Please Print) NAME OF REQUESTOR/AGENCY ORGANIZATION</p><p>SIGNATURE OF REQUESTOR DATE</p><p>********************************* FOR OFFICE USE ONLY ********************************* Waiver of Board Rules 2401 or 2402 Approved Denied SUPERINTENDENT OF SCHOOLS/DESIGNEE DATE</p><p> Beyond the Bell will provide signed/approved application to requestor. Requestor must provide approved copies to the site administrator indicated in the application. </p>