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9-12th Grade Football Band
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9-12th Grade Football Band
Student Information Form
Student Information Sheet - 2023-2024
Information collected here is entered into the CutTime database for use related to activities and communication within the James F. Byrnes High School band and guard program.
Student Information
Which band are you in?
*
Competition
Football (only)
Please choose your experience level
*
I'm brand new to the band, this is the first time I've filled out this form.
I am not new, but my information has changed. (new address, phone, etc)
I am not new, my information should be the same.
Student Name
*
First
Middle
Last
Student Address
*
Street Address
Address Line 2
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Student Home Phone (**Land Line Only**)
Student Mobile
Student Email
Enter Email
Confirm Email
Instrument (Choose only one)
*
Color Guard
Flute
Oboe
Clarinet
Saxophone
Bass Clarinet
Trumpet
French Horn/Mellophone
Trombone/Baritone
Tuba
Percussion
Synthesizer
Other
Student T-Shirt Size
*
Small
Medium
Large
X-Large
XX-Large
Grade (School year 2023-2024)
*
7
8
9
10
11
12
Student Gender
*
Female
Male
Student Date of Birth
MM slash DD slash YYYY
Parent / Guardian Information
Adult 1 Relationship to Student
Mother
Father
Stepmother
Stepfather
Aunt
Uncle
Grandmother
Grandfather
Guardian
Sister
Brother
Cousin
Other
Adult 1 Name
*
First
Last
Adult 1 Address
Same as student
Adult 1 Address (if different than student)
Street Address
Address Line 2
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Adult 1 Place of Employment | Occupation/Skills
Adult 1 Home Phone
Same as student
Adult 1 Home Phone (**Land Line** - if different than student)
Adult 1 Work Phone
Adult 1 Mobile
*
Adult 1 Email
*
Enter Email
Confirm Email
Adult 2 Relationship to Student
Mother
Father
Stepmother
Stepfather
Aunt
Uncle
Grandmother
Grandfather
Guardian
Sister
Brother
Cousin
Other
Adult 2 Name
First
Last
Adult 2 Address
Same as Student
Adult 2 Address (if different than student)
Street Address
Address Line 2
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Adult 2 Place of Employment | Occupation/Skills
Adult 2 Home Phone
Same as student
Adult 2 Home Phone (**Land Line** - if different than student)
Adult 2 Work Phone
Adult 2 Mobile
Adult 2 Email
Enter Email
Confirm Email
Emergency Contacts
Emergency contacts will be be contacted if a parent/guardian cannot be reached in an emergency. Please provide two emergency contacts in order of preferred contact)
Emergency Contact 1 Relationship to Student
*
Grandparent
Aunt/Uncle/Other Family
Adult Sibling
Friend
Neighbor
Other
Emergency Contact 1 Name
*
First
Last
Emergency Contact 1 Phone
*
Emergency Contact 2 Relationship to Student
Grandparent
Aunt/Uncle/Other Family
Adult Sibling
Friend
Neighbor
Other
Emergency Contact 2 Name
First
Last
Emergency Contact 2 Phone
Confirmation
Please enter the email of the person completing this form. A confirmation email will be sent to the email address for that person.
Confirmation Email
*
Enter Email
Confirm Email
Student Health Information
All health information is kept confidential.
Family physician
*
Family physician Phone
*
Student Health History
Food allergies (please type “none” if none)
Drug allergies (please type “none” if none)
Environmental/Seasonal allergies (please type “none” if none)
Student prescription medication list
STUDENT PRESCRIPTION MEDICATION LIST: (List all medications student is currently taking at home and/or school)
Medicine 1:
Time, Dose and purpose for medication
Medicine 2:
Time, Dose and purpose for medication
Check any box that applies below:
Record of illness, health problems the student currently has or has a history of:
ADD/ADHD
Arthritis
Autism
Asthma
Diabetes Type 1, IDDM
Diabetes Type 2, NIDDM
Hypoglcemia
Stomach problems/Gastric Reflux
Frequent Headaches
Migraines
Heart Disease
Seizures
Dizziness/Vertigo
Skin Disorder
Bladder/Kidney
Bowel/Colon
Vision/Glasses/Contacts
Hearing Aid/Hearing Loss
Mental Health/Emotional Condition
Mobility Devices
Other
Name of Health Insurance Company
*
Group or Identification number:
*
Parent/Guardian Permission
Parent/Guardian Permission
*
This is to certify that my student (type name below) has my permission to participate in all approved band trips, rehearsals and events during the 2022-2023 school year. I also understand that my son/daughter will be participating and that he/she is expected to abide by all school district rules and regulations during the course of the activity or trip. I understand that he/she will be chaperoned by school personnel and/or other approved volunteers. Additionally, if I cannot be reached, I understand and agree that my son/daughter may receive medical treatment in case of injury or illness during a band trip/event. I further agree to indemnify and hold harmless Spartanburg School District Five, staff or chaperones for any accidents, injuries or loss that may occur. The booster club and staff are not responsible for any theft, damage or loss to any instruments or other belongings during any band event. ***Please type student name below***
Signatures
Consent to to business electronically
*
The parties agree that this agreement may be electronically signed. The parties agree that the electronic signatures appearing on this agreement are the same as handwritten signatures for the purposes of validity, enforceability and admissibility. (type your full name as your electronic signature below)
Student Signature
*
I promise to follow all school rules and policies during any band related activities. I verify that the information completed is accurate and valid. I have read, understand and agree to the information in the band handbook and permission items listed above.
Parent Signature
*
I promise to follow all school rules and policies during any band related activities. I verify that the information completed is accurate and valid. I have read, understand and agree to the information in the band handbook and permission items listed above. (type your name as your electronic signature below)
Untitled
First Choice
Second Choice
Third Choice
Order Band Shoes
Order Band Shoes
Student Name
*
Place separate orders for each student.
First
Last
Purchaser Name
*
Enter the name of the purchaser
First
Last
Email
Enter the purchaser's email address
Enter Email
Confirm Email
Phone
*
Enter the purchaser's phone number
Order Shoes
*
Note: Band Shoes Choose "Shoes" option ONLY if purchasing new band shoes. First year band members will need to purchase band shoes (unless an older relative has some they can use). The cost is $45 per student. Shoe payment is due by Aug 15th. Returning Members: If your shoes from last year still fit and are in good shape, there is no need to purchase a new pair. If you do need a new pair, make sure you sign up for a spot on fitting day during summer practice so that we can place an order for your size.**
Shoes - ONLY if purchasing new shoes - $45
Processing
3.5% Processing Fee for Band Shoes ONLY
Price:
$0.00
Total
$0.00
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