UHS Band Health Form 2024-2025
Due prior to participation in any rehearsal or performance.
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Student Last Name *
Student First Name *
Date of Birth *
MM
/
DD
/
YYYY
School Student ID Number *
Primary Phone Number *
Parent/Guardian (First & Last Name) *
Parent/Guardian Email *
Parent/Guardian Employer *
Emergency Contact if parent/guardian cannot be reached (Name & Phone Number) *
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