SDMEA Middle School All State Jazz Band Emergency Contact Information and Photo Release and Consent Form

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This form is split into two sections. The first is emergency contact information in case we may need it at the event. The second section is a photo release and consent form. Please fill out each section completely.

Email *

Record my email address with my response

Student Name *

Student School *

Band Director's Name *

Emergency Contact #1 Name *

Emergency Contact #1 Relationship to student *

Emergency Contact #1 Phone Number *

Please list any allergies or health concerns: *

Does your student require special services to participate in this event? (interpreter, chair ramp, larger print music, sensory space, food, etc.) If so, please specify.

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