WMS BAND PARENTAL AND MEDICAL CONSENT FORM


STUDENT
Name: LAST __________________________ FIRST______________________ MI____
Email address: ______________________@______________________.______

LIST CONTACTS (parent or guardian on line 1):
Name________________________________ Phone#________________________ Relationship____________
Name________________________________ Phone#________________________ Relationship____________
Parent email address _______________________@______________________.______

MEDICAL:
STUDENT BIRTHDATE____________; FAMILY DOCTOR_______________________; HOSPITAL OF CHIOCE__________________;
MAJOR MEDICAL HISTORY or CONDITIONS____________________________________
____________________________________________________________________________________________
DAILY MEDICATIONS______________________________________________________
SPECIAL INSTRUCTIONS REGARDING MEDICAL CARE____________________________
___________________________________________________________________________________________
___________________________________________________________________________________________

PERMISSION AND CONSENT

This is a permission slip that gives permission for your child to participate in the regularly scheduled band events that occur each year. These include, but are not limited to the following: WMS Football Games, Buckwheat Festival parade, travel to Brooke High School for rehearsals and games, BHS Homecoming Parade, various Christmas Parades, Eighth graders participation in the BHS Homecoming Football Game half-time show, Wellsburg Applefest performance during school, Primary Schools Tour, concert band festival during school, and honors band attendance by select members. The times and schedules for these various activities will be posted on the band website: wmsband.net as soon as I know necessary information. In case of serious accident, injury or illness I understand that the persons listed above will be contacted in the order they are listed for directions on care for my child. If unable to reach a contact from above or in the case of an emergency situation, I hereby authorize Mr. Turner or any representative of him to render or secure any first aid that may be needed including treatment and/or transport to the nearest appropriate hospital by ambulance if necessary. I understand that the Brooke County Board of Education, Mr. Turner or any representative of him assumes NO responsibility for any unforeseen injury or accident which may occur in connection with any of the band's activities or field trips. Please print this form and return it to Mr. Turner at the beginning of each school year.

My child has my permission to attend and participate in any Brooke Board-approved activity regularly involving the band in performance. Any other special events will be provided by a separate permission slip. Also, I have read/reviewed with my child the band rules, procedures, and grading policy as stated on the band website: wmsband.net or have been provided a hardcopy of such.
____________________________________________
(Signature of Parent/Guardian)		 ________________________
(Date)
I would like to help chaperone the band: (circle)YESNO