2025-26 Tom C. Clark Band Parental Permission Form

  • Tom C. Clark Band Parental Permission Form 2025-2026

    General Information, Emergency Contact, Medical Release, Medical/Food Allergies , OTC Consent, , Photo Consent, Travel Agreement

  • Student Information

  • Choose 1 of the following*
  • My information has ...*
  • Birthdate*
     / /
  • Format: (000) 000-0000.

  • Parent/Guardian 1

  • Address Same as Student*
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Format: (000) 000-0000.

  • Parent/Guardian 2

    Leave Blank if none
  • Address Same as Student
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Format: (000) 000-0000.

  • In Case of Emergency

    Please list at least 2 emergency contacts. These can include the parents/guardians. Please list in the order you would like us to contact in the case of an emergency.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • I authorize Tom C. Clark Band Director(s) and/or Chaperone(s) to execute any and all documents necessary for my child 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.  Northside Independent School District does NOT assume financial responsibility but does wish to provide the best emergency care. By signing this form, you are giving the appropriate school personnel or chaperones authorization to call EMS or obtain medical care if you or the emergency contact(s) cannot be reached.*

  • Medical History

    (Food Allergies are on the next page)
  • Rows

  • Food Allergies

    All students are required to complete a food allergy form.
  • Format: (000) 000-0000.
  • Please select one.*
  • Rows

  • Over-the-Counter Medication Consent

  • I give permission for Tom C. Clark Band Director(s) or Chaperone(s) to administer Over-the-Counter medication if needed. (Tylenol, Ibuprofen, Benadryl, Anti-diarrheal, anti-nausea, etc.)*

  • Consent to Publish Student Names and Photos

  • I grant the Tom C. Clark Cougar Band Boosters permission to publish group or individual photos of my child on the Cougar Band Website (www.cougarband.org) and in other media sources (e.g., newspapers and  newsletters). I understand on the Cougar Band Website, only my child’s first name and first initial of his or her last name may appear, with the exception of the online Band Directory, which will include my child’s full name and will be accessible only with a password. I also grant permission for other media sources to publish my child’s full name.*

  • Travel Agreement

  •       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,      , authorize Justin Murphy and/or chaperones to execute any and all documents necessary for my child,        , 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.

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