STUDENT NAME: --------------------------------------------------
MAILING ADDRESS: --------------------------------------------------
HOME TELEPHONE: --------------------
STUDENT E-MAIL: --------------------
PARENT(S) NAME(S): -------------------------------------------------
PARENT E-MAIL: -------------------------------------------------
MOTHER�S WORK PHONE: -------------------------------------------
FATHER�S WORK PHONE: --------------------------------------------
PARENT�S CELL PHONE: ----------------------------------------------
INSTRUMENT MAKE: ----------------------------------------------------
SERIAL NUMBER: -------------------------------------------------------
(This information will be kept on file to assist families in case of lost or theft)
We have read and understand the Graham Junior High School Band Handbook. If we have any questions regarding participating in band or the program in general, we will contact Mr. Grubbs at 549-2002 or e-mail at [email protected].
STUDENT SIGNATURE: ------------------------------------------------
PARENT SIGNATURE: --------------------------------------------------
GJHS BAND TRAVEL PERMISSION FORM
I agree to allow my child to attend ALL BAND ACTIVITIES FOR WHICH HE/SHE IS ELIGIBLE. I understand that while student safety is a high priority for the District. Under State Law, the school is not responsible for medical costs associated with a student injury.
I expressively waive all claims for medical expenses, loss of services, or other claims, and I agree to indemnify and hold harmless the District, its Trustees, employees, and agents from all claims made against it or them on behalf of my child
I agree to indemnify and hold harmless the District, its Trustees, employees and agents from all claims made by third parties against it or them which result from my child�s actions on each trip.
I understand that the District, its Trustees, employees, and agents are not waiving any sovereign or governmental immunity, which it or they have under Texas Law.
I have read and understood this release and sign it voluntarily and with full knowledge of its significance.
STUDENT NAME: -------------------- ADDRESS:-------------------------
PARENT PHONE NUMBER:--------------- CELL PHONE:-------------------
PARENT ALTERNATE PHONE NUMBER: ----------------------------------
(This number could be an office phone, pager or other cell phone)
PERSON (OTHER THAN PARENT) TO CONTACT IN CASE OF EMERGENCY
NAME:------------------------- PHONE:-------------------------
(This information is very important. Please provide the name and number of a relative or family friend who will know how to find you in an emergency. Please do not use any of the phone numbers listed above. If your child is injured or becomes ill while away from school, it is vital that school personnel are able to contact you as quickly as possible.)
KNOWN ALLERGIES OR MEDICAL CONDITIONS: ----------------------------------------------------
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MEDICATIONS CURRENTLY USING:
INSURANCE CARRIER: POLICY #:
PARENT SIGNATURE: DATE: