UAMB Chaperone Application

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This application is for parents and/or guardians who have students in the Upper Arlington Band Program and may be interested in chaperoning for events other than football games. Please complete the application in its' entirety. Contact Wanda Berk at 614-746-7341 or wanda614@live.com if you have any questions or concerns.

Email *

Name (Last, First) *

Address *

Phone Number *

Are you certified medical personnel? *

Yes

If yes, check which apply

EMT

Nurse

Other:

Please list your chaperoning experience with the UAMB: *

Please list other chaperoning experiences *

Please list any skills you possess that would help the band at Disney and/or band camp *

It is the school policy for students not to smoke, use illegal drugs or alcohol, If you use any these substances, are you willing to not do so in front of the students as to not create a double standard? *

Yes

Trip to Walt Disney World (March 12-16, 2020)

I want to travel by bus with the students

I want to assist with events at the park and hotel

I am willing to do either

I am not interested in chaperoning the Disney Trip

Clear selection

Band Camp (August 3-8, 2020)

I am interested in being a chaperone at band camp

I am not interested in being a chaperone at band camp

Clear selection

As a chaperone, there may be times when you are asked to help with a task that may result in you missing your child's performance. This does not happen often, but you need to know that it is a possibility. If and when it happens, we will try to rotate assignments such that it does not happen to the same chaperone repeatably. Please be flexible if you are asked to perform such a duty. The head chaperone will contact you via e-mail concerning events you volunteered for. Please be diligent in checking the e-mail address you provide on a regular basis. Please read any email you receive in its entirety for special instructions.

I agree

I do not agree

I have read this form in its' entirety and I understand and agree to its content as a chaperone for the Upper Arlington Band Program

I agree

I do not agree

Clear selection

A copy of your responses will be emailed to the address you provided.

Submit

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