Parental Consent Form
Milton Chorus Overnight Trips
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Email
*
example@example.com
Student Name
*
First Name
Last Name
Student Non-School Email
*
example@example.com
Student Grade
*
Please Select
9th
10th
11th
12th
Student Primary Ensemble
*
Please Select
Bella Voce
Concert Choir
Select Womens
Chorale
Who is completing this form?
The PARENT/GUARDIAN listed above
The STUDENT listed above
NEITHER
Your Name
*
First Name
Last Name
Your Email
*
example@example.com
Relation to the student listed above:
*
A confirmation email will be sent to the email addresses listed above. Note that MHS student email accounts cannot receive emails from Jotform. Please keep this email for your records to confirm that your submission was received.
*
I understand
Student Information
Student Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Age
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Dietary Restrictions
*
None
Vegetarian
Vegan
Glutan Free
Dairy/Lactose Free
Emergency Contact Info
Emergency Contact 1
*
First Name
Last Name
Relation to Student
*
Phone Number
*
Phone Number (Alternate)
Emergency Contact 2
*
First Name
Last Name
Relation to Student
*
Phone Number
*
Phone Number (Alternate)
Medical Information
Medical conditions, allergies, etc. (If there are no known medical conditions please indicate.)
*
Please note that per Fulton County Schools policy all prescribed medications will need to be handled and distributed by a Fulton county schools employee.
*
I understand
Will your child need to TAKE any prescribed medications during our trip?
*
Yes
No
Fulton County Schools requires that all students who take medication during school trips have a completed SHS-1 Form on file. Please complete the form below (requires a Physician's Signature) and submit it to Milton Chorus before our date of departure. If a SHS-1 form is already on file you may obtain a copy and submit that instead.
*
I understand
List any prescribed medications your child will need to take during our trip.
All Medications should be in the original container. Make sure that clear instructions are included and that all meds are placed in a ziplock bag. Meds should be separated by time of administration: i.e. morning, during the day, or night.
*
I understand
Will your student need to CARRY WITH THEM a prescription inhaler, Epipen, Insulin, or other approved medical device?
*
Yes
No
Fulton County Schools requires that all students who carry medical devices during school trips have a completed SHS-2 Form on file. Please complete the form below (requires a Physician's Signature) and submit it to Milton Chorus before our date of departure. If a SHS-2 form is already on file with the school you may obtain a copy and submit that instead.
*
I understand
Make sure to bring AT LEAST two of any medical device, one for the student to carry with them and another for their chaperone.
*
I understand
Insurance Information
Insurance Co.
*
Insurance Carrier/Agent
*
Policy Number
*
Expiration Date
*
-
Month
-
Day
Year
Date
Opt-Out policy:
My student does not currently have insurance.
Student Acknowledgment
I have reviewed the TRAVEL POLICIES and PROCEDURES section in the handbook and understand the following policies:
*
I understand that all regular school rules will be enforced during all trips including prohibitions on drugs, alcohol, and smoking/vaping.
I understand that I am expected to show respect to all trip chaperones.
I understand that my behavior reflects Milton Chorus and the school, and will behave and dress appropriately during travel time.
I have reviewed the additional Travel Policies of Milton Chorus listed in the handbook and agree to abide by their requirements as I represent Milton High School in the community at-large.
Student Name
*
First Name
Last Name
Today's Date
-
Month
-
Day
Year
Date
Student Signature
*
Parent/Guardian Acknowledgment
I have reviewed the TRAVEL POLICIES and PROCEDURES section in the handbook and understand the following policies:
*
I understand that all regular school rules will be enforced during all trips including prohibitions on drugs, alcohol, and smoking/vaping.
I understand that my child is expected to show respect to all trip chaperones.
I understand that my child behavior reflects Milton Chorus and the school, and will help them behave and dress appropriately during travel time.
I have reviewed the additional Travel Policies of Milton Chorus listed in the handbook and agree to support the behavior requirements for my student as they represent Milton High School in the community at-large.
Parent/Guardian Acknowledgment
*
I certify that the above medical and emergency information is correct.
I give permission for the directors to seek emergency medical treatment for my child in the event that a parent or guardian cannot be reached.
Parent/Guardian Name
*
First Name
Last Name
Today's Date
-
Month
-
Day
Year
Date
Parent/Guardian Signature
*
Submit
Should be Empty: