King Philip Summer Steel Band 2019
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Participant's First Name *
Participant's Last Name *
Participant's Home Street Address *
Town *
Home Phone *
Student Email *
Primary Instrument *
Grade in School *
Parent/Guardian One First Name
Parent/Guardian One Last Name
Parent/Guardian One Cell Phone
Parent/Guardian One Email Address
Parent/Guardian Two First Name
Parent/Guardian Two Last Name
Parent/Guardian Two Cell Phone
Parent/Guardian Two Email Address
Permission and Discipline Guidelines *
I give my son/daughter permission to participate in the Summer Steel Band. I understand there will be trips to perform at the Pan Mass Challenge, Norfolk Community Day, Norfolk Concert on the Common and give permission to my son or daughter to participate on these trips. Information and itineraries will be provided by email when these events arise. Please make a check payable to KPMA for $150 and place in Karen Wolf's mailbox.  I also give permission for my son/daughter to travel on a school sponsored bus for King Philip Regional School District Music functions and understand my student must adher to the discipline guidelines in the KPHS Student Handbook.
Required
Signature Name *
 Medical Treatment *
Medical Treatment Authorization I hereby give my permission for my son/daughter to participate in all King Philip Regional School District Music Program sponsored activities and functions. My signature below conveys authority for over the counter comfort medication to be dispensed by a designated King Philip chaperone. In case of medical emergency, I understand every effort will be made to contact parents/guardian. In the event I cannot be reached, I hereby give permission to the physician selected by the Director of Music of the King Philip Regional School District to hospitalize, secure proper treatment for, order injections, anesthesia, or surgery for my child. I agree to be responsible for any out-of-pocket expenses or copayments incurred.
Required
Signature Name *
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