RETURN

Complete this form online and "PRINT" a copy.
Then click "SUBMIT" to register.
You MUST sign the completed copy and deliver it to the band director along with a copy of the "Band Rules and Policies".

   

 2010 - 2011
Warner Robins HS
Marching Band
Registration Form		  
Student will be participating in: (check all that apply)
  Program Instrument Personal
Instr		 School's
Instr
Marching Band

Color Guard

N/A
Concert Band

Jazz Band

  (pending tryouts)      
 

STUDENT INFORMATION

Last Name:

First Name:

Sex:

2010/2011 Grade:

Name Called:

Birth Date:

Age:
Home Address:

Zip:
Home Phone:

Student Cell#:

Student Email:
 

FAMILY INFORMATION  (In case of emergency, please check whom to contact)
Mother/guardian's name:

Employer:
Home Address (if different):
Home Phone:

Work Phone:

Cell #:
Email:
         
Fatherguardian's name:

Employer:
Home Address (if different):
Home Phone:

Work Phone:

Cell #:
Email:
 

MEDICAL INFORMATION  (Check all that apply to your student)
Allergies:
History of:

Asthma

Cardiac Problems

Diabetes

Seizures

Emotional, behavioral, intellectual or physical challenges
Explanation:
Name of Medication (include dosage & Frequency):
Purpose and/or special circumstances regarding medications:
Date of last Tetanus booster:
 

EMERGENCY INFORMATION 
Student Physician Name:

Phone #:
Insurance Company:

Policy Number:
If Mother/father cannot be reached, call:
Name:

Relationship:
Home Phone:

Work Phone:

Cell #:
 

 

 

 

 

 

 

 
     
 
 
  I GIVE MY PERMISSION TO THE DESIGNATED ADULT IN CHARGE OF FIRST AID TO ADMINISTER THE FOLLOWING TO MY STUDENT AS NEEDED: Simple First Aid     Tylenol     Advil     Benedryl     Antacids  
     
  I, , HEREBY GIVE THE WRHS BAND DIRECTOR AND HIS/HER DESIGNEE
  PERMISSION TO SECURE MEDICAL ASSISTANCE FOR MY STUDENT IN THE EVENT OF AN EMERGENCY.
   
  *THE WARNER ROBINS HIGH SCHOOL BAND DIRECTORS CAN ONLY RELEASE STUDENTS TO THEIR LEGAL GUARDIANS.*
     
PARENT SIGNATURE:  

Date:

  

 

  

     

 
 

Complete this form online and "PRINT" a copy.
Then click "SUBMIT" to register.
You MUST sign the completed copy and deliver it to the band director along with a copy of the "Band Rules and Policies".