Color Guard

Student Information

Which band are you in?*

Please choose your experience level*

Student Name*

First Middle Last

Student Address*

Street Address Address Line 2 City State ZIP Code

Student Home Phone (**Land Line Only**)

Student Mobile

Student Email

Enter Email Confirm Email

Instrument (Choose only one)*

Student T-Shirt Size*

Grade (School year 2023-2024)*

Student Gender*

Female
Male

Student Date of Birth

Parent / Guardian Information

Adult 1 Relationship to Student

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 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

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 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*

Emergency Contact 1 Name*

First Last

Emergency Contact 1 Phone*

Emergency Contact 2 Relationship to Student

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:

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)