Eden HS Band
This is the Eden HS Band registration form. Please fill out each page with as much accuracy as possible. All information gathered will only be used for emergencies and UIL compliancy. Thank you for being a part of the HS Band!
Student's Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
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Eden HS Band
Parent Information
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Email
*
example@example.com
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Interest in Band Boosters?
*
Please Select
Yes
No
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Eden HS Band
General Information
Grade
*
Please Select
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
T-Shirt Size
*
Please Select
XS
S
M
L
XL
XXL
XXXL
Shoe Size (men's sizing)
*
Instrument
*
Please Select
Flute
Clarinet
Bass Clarinet
Alto Saxophone
Tenor Saxophone
Trumpet
French Horn
Trombone
Baritone
Tuba
Percussion
I own my own instrument.
*
Yes
No
I would like information about where to purchase an instrument.
*
Yes
No
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Eden HS Band
Medical Information
Student
Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
Emergency Contact
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Relationship to Student
*
ex. mother, grandma, father, etc.
In Case of Emergency
Primary Care Doctor Name
*
First Name
Last Name
Primary Care Doctor Phone Number
Please enter a valid phone number.
Dentist Name
First Name
Last Name
Dentist Phone Number
Please enter a valid phone number.
Current Medical Conditions
*
Please include ALL conditions that may interfere with band rehearsals, performances, and events. If none, type n/a.
Approved Medications and Dosages
*
Please include all medications that your student takes, including over the counter medications. (EX. Tylenol-500mg, Ibuprofen- 200mg, Benedryl-25mg) If none, type n/a.
I give permission for my student to take the above medication and dosages.
*
Allergies
*
Food, medication, etc. If none, type n/a.
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Please let me know anything else that you/your child may need me to know!
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