2022-2023 Stewarts Creek Choirs Student & Family Registration Form and Contract

2022-2023 Stewarts Creek Choirs

Medical Information and Release Form
Your child's Primary Physician Name *
Enter physician name or N/A
Primary Physician Phone *
Emergency Contact Name if Parent(s)/Guardian(s) Cannot be Reached *

First Name Last Name
Emergency Contact Cell Phone Number *
Emergency Contact Relation to Student *
Vision and Audiology (Check All That Apply)

Glasses Contacts Hearing Aid
Has your child ever received a Tetanus Shot? *

Yes No
Do you know the date of your child's last Tetanus Shot? *

Yes No
Date of student's last tetanus shot: *
MM-DD-YYYY
Does your child carry / require an EPI Pen? *
Does child carry / require an Asthma Inhaler? *
Does child have a nut allergy? *
Please list your child's known food or medication allergies, or enter "N/A" if none. *
Please list your child's known medical conditions or enter "N/A" if none. *
Please list your child's prescription/over-the-counter medications being taken or enter "N/A" if none. *
Health Insurance Company Name *
Enter insurance company or N/A
Insurance Policy Number *
Enter insurance policy # or N/A
Consent and Agreement

In the event that {studentName} is presented for, or requires medical treatment or surgery or any other form of medical care or aid, I, {primaryParentguardian26}, as the parent/legal guardian of the above named student, do hereby authorize the Directors/Chaperones standing in loco parentis to be consulted with, and consent to, any medical treatment or care deemed necessary by any doctor, nurse or other medical personnel. I also guarantee payment of all charges incurred for medical treatment such as, but not limited to physician, hospital, x-ray, lab, drugs, and EMS. (For emergency use only. Every effort will be made to contact parent/guardian prior to treatment). I agree to indemnify and hold harmless the choir directors, staff and chaperones of Stewarts Creek High School Choirs, Stewarts Creek High School, and Rutherford County Schools, its agents and employees for any and all claims, demands, actions, rights of actions and/or judgments by or on behalf of the above named student arising from or on account of said procedures and/or treatment(s) rendered in good faith.

By entering my name below, I {primaryParentguardian26}, attest that I am a parent or legal guardian of {studentName} and that the medical information provided on this form is accurate. I hereby consent and agree,
Parent/Guardian Signature for Medical Release Form *

First Name Last Name
Signature *

Clear
Medical Release Form Authorized, this date: *

Month Day Year
Date

2022-2023 Stewarts Creek Choirs

Over-the-Counter (OTC) Medication Consent Form
Indicate if you wish to allow Parent Chaperones and/or Choir Directors to administer non-prescription medications to {studentName} on occasions when Stewarts Creek High School Choirs events are held off-campus or at times when Stewarts Creek High School Choirs events are held when school is not in session or at other times as needed. If so, selected medications will be administered only when symptoms warrant and will be given in strict compliance with package directions regarding age, dosage and frequency.
Over the Counter Medication Directive *

Do not administer any over-the-counter medication. Administer over-the-counter medication(s) specified below:
Select Over the Counter Medications to be Administered *

Acetaminophen (Tylenol) Ibuprofen (Advil) Bismuth Subsalicylate (Pepto Bismol) Benadryl Calamine Lotion Neosporin or First Aid Cream Bee/Insect Sting Topical Analgesic
By entering my name below, I, {primaryParentguardian26}, attest that I am a parent or legal guardian of {studentName} and that the Over-the-Counter (OTC) Directive information is accurate.
Parent/Guardian Signature for OTC Directive Form *

First Name Last Name
Signature *

Clear
OTC Directive Form Authorized, this date: *

Month Day Year
Date

2022-2023 Stewarts Creek Choirs

Travel Permission and Activity Consent Form
Officially sanctioned events and activities requiring off-campus travel, involve student choir members leaving from, and returning to, Stewarts Creek High School (or other designated locations) at announced times and in an organized fashion will take place each academic year. Travel to officially sanctioned events will primarily occur on school buses driven by Rutherford County School employees or approved operators or on commercial charter buses when applicable.

Student choir members are responsible for abiding by the rules and policies of Stewarts Creek High School Choirs, Stewarts Creek High School and Rutherford County Schools at all activities. All rules and regulations will be clearly stated prior to events. In case of serious violation of any rules or regulations, parents/guardians will be notified by telephone, if possible, and arrangements will be made for the child to return home. Should the above discipline be necessary, parents/guardians will be responsible for any expense incurred.

Not all events and activities will apply to all choir members and there may at times be officially sanctioned events that involve a particular section or particular members of the Stewarts Creek High School Choirs. There may also be times when a small number of choir student members are involved in officially sanctioned events and activities where travel via bus would be impractical. In such cases students may be asked to drive themselves (with parent permission) or ride with an approved parent/guardian driver to and from these activities. Parents/guardians will be notified in advance when such circumstances should arise.

Specific schedules – i.e. “Gig Sheets” will be available the week of each event. Events, activities, times, and locations are subject to change.

I attest that I, {primaryParentguardian26}, am a parent or legal guardian of {studentName} and have read and understand the travel requirements of Stewarts Creek High School Choirs, including expected behavior of choir members and remediation if problems arise. I give permission for my child to travel in all modes described herein for all officially sanctioned events and performances of the Stewarts Creek High School Choirs . I furthermore give permission for my child to participate in all officially sanctioned events and activities of the Stewarts Creek High School Choirs, and that this permission shall remain in effect for the duration of one calendar year from the authorized date on this form.
Parent/Guardian Signature for Travel Permission and Activity Consent Form *

First Name Last Name
Signature *

Clear
Travel Permission and Activity Consent Form Authorized, this date: *

Month Day Year
Date

2022-2023 Stewarts Creek Choirs

Uniform Agreement Form
All students issued school-owned choir robe agree to treat them with respect and take measures to avoid loss or damage.

Replacement values of each choir robe is $50.00.

By entering my name below, I attest that I, {primaryParentguardian26}, am a parent or legal guardian of {studentName} and I agree to the terms of the Uniform Agreement Form.
Parent/Guardian Signature for Uniform Agreement Form *

First Name Last Name
Signature *

Clear
Uniform Agreement Form Authorized, this date: *

Month Day Year
Date

2022-2023 Stewarts Creek Choirs

Family Financial Contribution Agreement Form
The Stewarts Creek High School Choirs program is a co-curricular activity, with activites in and out of school. Participation in choir is not a requirement for graduation, but rather is a voluntary and elective choice.

Because annual funding through the Rutherford County School budget accounts for a small fraction of the total needed for the fundamentals of an effective choir program, funding for about 95% of the overall annual budget is requested as an investment from each family in the form of a financial contribution. We ask that each student contribute $65 as a required class fee.

No student will ever be denied participation in the Stewarts Creek High School Choirs due to a family’s inability to contribute financially. Fundraisers are setup to help students and families make their contribution.

If there is ever a financial situation that arises, please do not hesitate to contact the choir directors. We are here to help. Communication is the key. To avoid report cards and/or student records/transcripts being held, we ask that all families contact the choir directors to settle all class fee obligations. We must also insist that all financial obligations must be current or paid in full in order for students to participate in optional special trips.

Students approved for Free/Reduced Lunch or RCS Fee Waiver will have the $65 Choir Class Fee waived; however, other fees (for honor choirs, special trips, etc), cannot be waived and are expected to be paid in full.

By entering my name below, I attest that I, {primaryParentguardian26}, am a parent or legal guardian of {studentName}. I understand that my child's participation in the Stewarts Creek High School Choirs is both a co-curricular activity and elective choice not required for graduation. I agree to satisfy my financial contribution to the Stewarts Creek High School Choirs as outlined above.
Parent/Guardian Signature for Financial Contribution Agreement *

First Name Last Name
Signature *

Clear
Financial Contribution Agreement Authorized, this date: *

Month Day Year
Date

2022-2023 Stewarts Creek Choirs

Calendar Agreement Form
The Stewarts Creek High School Choirs function on a high level due to the coordinated efforts of Stewarts Creek Administration, Faculty, and Parents; we cannot be successful without everyone present at all in-school and after-school choir events. Be proactive in maintaining a personal calendar with your dates for family, church, sports, choir, etc. Communicate any potential conflicts that might arise to choir directors, coaches, etc.

Please familiarize yourself with the Choir Handbook (found at www.StewartsCreekChoirs.com), which includes specifics on call times, how performances are graded, and alternative assignments to missed performances.

The Stewarts Creek Choir Calendar can always be found at www.StewartsCreekChoirs.com or on the Stewarts Creek High School website for reference throughout the year. However, please make yourself aware now of the following major choir events:
- August 5-6, 2022. Fall Choir Retreat (3rd and 6th period choir students only)
- September 27, 2022. 7pm. Fall Choral Concert
- October 27, 2022. 6pm. Choral Extravaganza
- December 9 & 10, 2022. 7pm. December Choral Concert
- February 7, 2023. 7pm. Choral Pre-Adjudication Concert
- February 14-17, 2023. Regional Adjudication (likely to be an in-school field trip one of these days with possibility of performances extending into the late afternoon/early evening)
- April 11, 2023. 7pm. Spring Choral Concert
These are selected events only that impact a large group of our students; many other events can be found on the choir calendar (honor choirs, etc). Put the above events on your calendar now and please do not schedule any other events on these dates.

By entering my name below, I attest that I, {primaryParentguardian26}, am a parent or legal guardian of {studentName}. I understand that a comprehensive choir calendar is available at www.StewartsCreekChoirs.com. Our family has scheduled the dates listed above on our family calendar and AGREE NOT TO SCHEDULE OTHER EVENTS (family vacations, doctor visits, church retreats, etc) ON THESE DATES. I understand that only school-related conflicts (such as school-sanctioned clubs, athletics, etc) can be excused absences from any choir event, and we agree to communicate conflicts with choral directors as soon as they arise.
Parent/Guardian Signature for Financial Contribution Agreement *

First Name Last Name
Signature *

Clear
Calendar Agreement Authorized, this date: *

Month Day Year
Date

2022-2023 Stewarts Creek Choirs

Handbookand Polices Signature Form
NOTE: Please refer to the
Stewarts Creek Choirs Handbook
on the choir website:
www.StewartsCreekChoirs.com

Located under the Forms/Handouts page
As a student member, I have read, understand, acknowledge, and accept the rules and policies governing my participation in the Stewarts Creek High School Choirs. Realizing that my best performance and contribution to my school and our choir progam will result from my adherence to those rules and guidelines, I accept the responsibilities and privileges associated with membership in the Stewarts Creek High School Choirs. *

First Name Last Name
Student Signature *

Clear
Date *

Month Day Year
Date
As a parent/guardian, I have read, understand, acknowledge, and accept the rules and policies governing my child’s participation in the Stewarts Creek High School Choirs.

First Name Last Name
Parent Signature *

Clear
Date *

Month Day Year
Date

2022-2023 Stewarts Creek Choirs

Registration Completion
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