Emergency Medical & Contact Information
(CAN ALSO BE COMPLETED ONLINE AT CARLYNTONBAND.COM - PARENT/GUARDIAN PAGE) Mandatory for band camp attendance, Due August 1st, 2022
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Student's Name *
Student's Grade Level *
Instrument and Section *
Address *
Primary Phone Number *
Parent/Guardian Contact Number: *
Parent/Guardian Name(s) *
Parent/Guardian Relationship to student *
Address (If different than student's)
Allergies or Allergic Reactions
In Case Of Emergency, Please Contact This Parent/Guardian: *
Address of emergency contact: *
Phone number 1 for emergency contact: *
Phone number 2 for emergency contact:
Emergency Contact's Relationship to the Student: *
As the parent / Guardian of the above named student, I recognize that as a result of participation in Marching Band, medical treatment on an emergency basis may be necessary. I further recognize that band personnel may be unable to contact me for my consent for emergency medical care. ln this case, I authorize band personnel or chaperones to act on my behalf according to their best judgment in an emergency requiring medical attention for which service I will pay. *
Required
Are you ok with communication via text? *
Best number to receive text message reminders: *
Contact information is used primarily by Board Members  but in the past has been shared with all band families.  Please choose ONE of the two options to indicate whether you do/do not agree to sharing your contact information with all band families. *
The band photographs are often shared on the band website and social media sites. Please mark this response ONLY if you do NOT give permission for the band parents' association to use pictures on Carlynton band social media sites or in print that may contain your student.  Please reach out with any questions.
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