2025-26 Tom C. Clark Band Parental Permission Form

Returning MemberNew Member

Not changed since last year. (Returning Members only.)ChangedNew Member

Street Address

Street Address Line 2

CityState

Zip Code

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E-Mail that is not the NISD District Issued.

Street Address

Street Address Line 2

CityState

Zip Code

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Confirmation EmailCONFIRM EMAIL

ALTERNATE EMAIL ADDRESS

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Welding, Carpentry, Information Technology, Photography, Sewing, CDL, etc.

Street Address

Street Address Line 2

CityState

Zip Code

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Confirmation EmailCONFIRM EMAIL

ALTERNATE EMAIL ADDRESS

Please enter a valid phone number.

Welding, Carpentry, Information Technology, Photography, Sewing, CDL, etc.

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I consentI do NOT consent

	Please Explain
Convulsive Disorder
Visual Problem (Beyond Glasses)
Orthopedic Disability
Auditory
Heart Condition
Speech
Diabetes
Asthma
Other

e.g. Latex, Sulfa, etc.

Please enter a valid phone number.

My child does NOT have any food AllergiesMy child DOES have Food Allergies. I have listed them below

	Yes
Peanut
Tree Nuts
Wheat / Gluten
Fish
Shellfish
Soy
Milk
Eggs
Other

I ConsentI do not wish for my child to be published on any social media platform or website.

First Name Last Name has my permission to travel with the Clark Band to all 2025-2026 regional band events. I understand the organization will leave from school several times a year, please see messages through CutTime and the Cougar Band website, www.cougarband.org, for dates and times. I will not hold Northside Independent School District or its employees liable for accidents or injury, which may occur while on the above-described trip. I further understand that any student acting as a representative of a Northside School or the District (including practice, competition, travel to and from the event, or other related activities) who displays conduct which is disruptive or detrimental to the program including but not being limited to, being in possession or under the influence of alcohol, marijuana, hallucinogenic drugs or other prohibited substances of any kind, or the attempting to sell, distribute, or to use said prohibited items on campus of any school in the District or any activities mentioned above will be subject to immediate withdrawal from the program for the remainder of the school year and/or placed under suspension, placed in an alternative program, or expulsion from school. See T. C. Clark High School/NISD student hand book for additional requirements and outcomes.

I, Parent First Name Last Name, authorize Justin Murphy and/or chaperones to execute any and all documents necessary for my child, First Name Last Name , to be treated by a medical doctor or at a medical facility, whether on an emergency or non-emergency basis should it be deemed necessary for his/her care and general welfare.

Tom C. Clark Band Parental Permission Form 2025-2026

Student Information

Parent/Guardian 1

Parent/Guardian 2

In Case of Emergency

Medical History

Food Allergies

Over-the-Counter Medication Consent

Consent to Publish Student Names and Photos

Travel Agreement