WHMS Band Forms 2020-2021
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STUDENT INFORMATION
Student Name *
Student I.D. Number *
Student Age *
Student Grade *
Birthdate *
MM
/
DD
/
YYYY
Gender *
Student Email *
(NOT a Hall County email!  This should be an email address that can receive emails about band.)
Student Phone Number
Student lives with... *
Band Class Period *
Student Address *
PARENT + GUARDIAN INFORMATION
Guardian 1 Name + Relationship *
Guardian 1 Address *
Guardian 1 Cell Phone Number *
Guardian 1 Work Number
Guardian 1 Email
Guardian 2 Name + Relationship
Guardian 2 Address
Guardian 2 Cell Phone Number
Guardian 2 Work Number
Guardian 2 Email
STUDENT Signature (Not Parent) *
STUDENT COMMITMENT ACKNOWLEDGEMENT:  As the student named in this form, I hereby promise to always try my hardest, even when things get challenging, because trying and failing at something is often the first step to succeeding.  I promise to take good care of my instrument.  I promise to respect myself, other people, and all band equipment.  I will come to band class with a positive attitude.  I will practice.  Most importantly, I will tell Ms. Foster if something is wrong, so that she may help me find a solution.
EMERGENCY CONTACT + INSURANCE INFORMATION
Emergency Contact *
Emergency Contact Phone Number *
Insurance Carrier *
Insurance Policy # *
GENERAL MEDICAL INFORMATION
Please list any chronic health problems: *
Or respond with "N/A"
Please list all allergies including medical, food, and environmental: *
Or respond with "N/A"
Does student have asthma? *
Does student carry an Epipen, Auvi-Q, or inhaler? *
List medications taken on a regular basis: *
Or respond with "N/A"
PHYSICIAN INFORMATION
Please list your student's primary care physician, or N/A if they do not have one.  
*If there is an incident warranting a hospital visit, we will take them to the nearest hospital available.
Physician Name/Practice *
Physician Phone Number *
Physician Address *
PARENT PERMISSIONS
*All information provided on this form is private and confidential and will only be used when needed.
Please select the over-the-counter medications that CAN be provided to your student: *
Required
In case of minor illness, the West Hall Band Directors or chaperones have my permission to administer the above over the counter drugs to my child. *
Parent/Guardian Signature *
Please type your full name to signify that you have read and understand the above statement.
EMERGENCY WAIVER and MEDICAL CONSENT
I, the undersigned parent/guardian of the student listed in this form, hereby grant authorization to a Band Director or any chaperone of the West Hall Band Program standing in loco parentis, to obtain any emergency medical and/or surgical procedures from a physician or hospital emergency room physician on behalf of the above-named minor.  (Sign below.)
Parent/Guardian Signature *
Please type your full name to signify that you have read and understand the above statement.
MEDIA  RELEASE ACKNOWLEDGEMENT
As the parent/guardian of the student named in this form, I hereby consent to the participation in interviews, the use of quotes, and the taking of photographs and/or video of the student named above by the West Hall Band Program.

I also grant the right to edit, use, and reuse said products for nonprofit purposes including use in print, on the internet, and all other forms of media. I also hereby release the Hall County Public School System and its agents and employees from all claims, demands, and liabilities whatsoever in connection with the above.
Parent/Guardian Signature *
Please type your full name to signify that you have read and understand the above statement.
HALL COUNTY BOARD OF EDUCATION RELEASE ACKNOWLEDGEMENT
School functions and trips for the 2020-2021 school year may include football games, indoor and outdoor rehearsals, LGPE festivals, service projects, concerts, and trips, depending on their grade level.

I, the parent/guardian of child listed on this form, hereby consent to my child’s participation in school trips listed above.

I further acknowledge and agree to the following:
 ● The Hall County Board of Education, Its members, employees, and agents assume no responsibility for personal injuries and/or property damage which might be suffered by my child, their property, or the person or property of others during said function/trip, and hereby expressly release said Board of Education, its members, employees, and agents from any and all liability relating to such injuries/damages.
● The Hall County Board of Education’s policies on Student Conduct and Discipline shall be in full force and effect as to all student participants in this function/trip at all times during the same, and any violation of any rules contained therein by my child may result in appropriate disciplinary measures includes suspension and expulsion as provided in said policies.
 ● The Hall County Board of Education, its members, employees, and agents are not responsible for any expenses related to this school function/trip except as otherwise specifically agreed to them in writing.
● The Hall County Board of Education may require as a condition of my child’s participation in this school function/trip that satisfactory evidence be submitted indicating that my child has sufficient medical insurance in effect during the period of the said function/trip.

Parent/Guardian Signature *
Please type your full name to signify that you have read and understand the above statement.
STUDENT Signature (Not parent) *
Please type your full name to signify that you have read and understand the above statement.
BAND PARTICIPATION AND FINANCIAL AGREEMENT
I agree to meet the time and monetary commitments for the West Hall Middle School Band Program for the 2020-2021 school year as outlined in the WHMS Band Handbook and understand that all program fees and payments are non-refundable.
Parent/Guardian Signature *
Please type your full name to signify that you have read and understand the above statement.
STUDENT Signature (Not parent) *
Please type your full name to signify that you have read and understand the above statement.
WEST HALL BAND STUDENT AND PARENT HANDBOOK ACKNOWLEDGEMENT
I have read and understand the contents of the 2020-2021 Band Handbook and have reviewed the band calendar. I understand that it is also posted on the band website.
Parent/Guardian Signature *
Please type your full name to signify that you have read and understand the above statement.
STUDENT Signature (Not parent) *
Please type your full name to signify that you have read and understand the above statement.
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