2024 Health And Wellbeing Profile
The Mason Bands program partners with families to provide the best care for students’ health & well being throughout their participation in Marching/Concert Bands and Winter Guard programs.  The information shared in this Health & Well-Being Profile will be used by Mason Bands Staff and Band Aids to provide the best care for your student. Additionally, parents are encouraged to fill out a Student Care Plan to share more detailed information if applicable for their student.
Email *
Full Name Of Person Completing This Form *
Phone # Of Person Completing This Form *
Email Of Person Completing This Form *
Student ID *
IMPORTANT! Please ensure you enter the correct student ID. We rely on this information to link data for your student and if you enter it incorrectly, it will not match across our records.
Student First Name *
Student Last Name *
Submit SCP?  *
Do you plan to submit a Student Care Plan (SCP) for your student?
Condition/Concern
If you plan to submit a Student Care Plan, please list your student's allergy, condition, or concerns:
Dietary Need *
Please select the dietary needs that apply to your student:
Required
Dietary Info
Please add any additional notes that would be helpful for meal planning, if any.
Medication Policy Agreement *
By signing your name, you acknowledge you have read and understand the Mason Band Medication Policy.
CENTRAL OTC MEDICATIONS
Mason Bands maintains central supplies of typical over the counter (OTC) medication including: acetaminophen, ibuprofen, and Benadryl. We encourage parents/guardians to provide access to central OTC medications if your student has ever needed one of these medications in the past. A Dispensing Medication at School (DMS) form signed by both a parent/guardian and a doctor is required for each medication to be dispensed.

If a student needs one of these medications but does not have a DMS on file, the medication will not be given.
Central OTC Plan *
Do you plan to submit a DMS form(s) for your student to have access to 1 or more centrally provided OTC medications?
Decline Central OTC
By signing below, you confirm your student will not have access to Central OTC Meds from Band Aids/Directors at rehearsals, camps, events, and travel.
Student Carry? *
If your student carries emergency medication such as an inhaler, epinephrine, glucagon, etc., please let us know. For all students who carry emergency medication, a Dispensing Medication at School (DMS) form and Student Care Plan (SCP) are required. In addition, we recommend you turn in a backup medication for our Band Aids to carry for your student.
Required
Med Drop Off Plan? *
Required
If you have any questions, send email to MedicalSecretary@masonbandboosters.com
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