All-Abaco Community Marching Band

Personal Health & Medical Information

To be completed by Parent/Guardian
Parent/ Guardian Name

First NameLast Name
Address

House No.

Street Address

SettlementIsland

Country
In the event of an emergency, please contact:

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
List any medication to be taken:
List any allergies:
List any physical or behavioral conditions that may affect or limit full participation in activities:
IParent/Guardian understand every effort will be made to contact me. In the event that I am unable to be reached, I hereby give permission to the licensed healthcare practitioner selected by the Adult Leader in charge to secure proper treatment, including hospitalization anesthesia, or injections of medication for my child.
Parent/Guardian Signature
Date

MonthDayYear
Date

Band Mouthpiece/Instrument Release Information
Your childInsert band member name* is a member of the above captioned community marching band. In order for your child to become an exceptional and talented e musician, he/she must take time to practice using their assigned instrument and mouthpiece at home. If you agree for your child to practice using both the mouthpiece and instrument at home, please sign your name to the bottom of this release form.

By signing this form, you are now responsible for the mouthpiece and instrument should it be destroyed or misplaced. Consequently, you will be required to purchase the mouthpiece and/or instrument that was in your child's possession.
I, Insert Parent/Guardian Name* Parent of Insert child's name* will pay for the mouthpiece and/or instrument that my child damaged and/or misplaced.
Band Member Signature
Parent/Guardian Signature
Should be Empty:

Personal Information