All State Chaperone Interest Form
All chaperones are required to be members of MMEA. Click here to join/renew your membership: https://www.mdmea.org/membership-1

Please read the MMEA Code of Conduct for Leaders, Staff, and Volunteers before completing the form: https://www.mdmea.org/codes-conduct-training 
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MMEA/NAfME Member Number *
Full Name *
Pronouns (Ex. he/him, she/her, they/them. etc.)
Preferred email address *
Preferred phone number *
Where do you teach? (school) *
School system where you teach *
Which ensemble would you like to chaperone? *
Have you served as a chaperone previously? *
Briefly outline your interest and qualifications for serving as an All State chaperone *
Have you ever been accused, charged with, or alleged to have committed any act of neglect, abuse, or molestation against a minor? (if yes, see below)
Clear selection
If yes, explain in detail, providing date and place of incident
I consent to sign this form electronically. (insert initials) *
I have read and agree to the MMEA Code of Conduct for Leaders, Staff, and Volunteers. (insert initials) *
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