STUDENT CLUB OPT-OUT FORM

Name of Student:______________________________________________________________________

School of Attendance:___________________________________________________________ _______

Your child may become a member of student clubs at the school. A list of existing student clubs are available on the school’s website: https://chs.cusd.com/Clubs.aspx.

Please list below any student clubs in which you do not wish for your child to become a member. You may update this list by completing and submitting a new Student Club Opt-Out Form. Please submit the completed form to the Activities Office at the school.

1. ________________________________________________________________________________

2. _________________________________________________________________________________

3. _________________________________________________________________________________

4. _________________________________________________________________________________

5. _________________________________________________________________________________

6. _________________________________________________________________________________

7. _________________________________________________________________________________

8. _________________________________________________________________________________

9. _________________________________________________________________________________

10. _________________________________________________________________________________

(if extra spaces needed, add page(s))

Parent/Guardian: By signing below, I represent that I am the parent or legal guardian of the above-listed student and I do not permit my child to become a member of the student club(s) listed above. I understand that the school will exercise reasonable diligence in notifying me if my child is a member of the above-listed clubs but that the decision regarding my child’s membership and participation in such club(s) is my responsibility and that of my child.

Signature	_____________________________________________	Date ______________________

Print Name _____________________________________________

Doc# 68251-2, 03/2023