2026 Medical Form

Medical Form

Cascade High School Marching Band
Student's Name

First NameMiddle NameLast Name
Please take a moment to complete the following information.
List any physical restrictions (if any).
List any food allergies.
List any other allergies that may affect participation, especially during marching season.
List any Over the Counter Medicine (OTC) restrictions. (OTC medicines they cannot have.) OTC medication may be dispensed for headaches, colds, sore throats, etc.
List any medications that your child is allergic to (for hospital purposes)
Participation Release:

By signing this form, my student, {studentsName}, has my permission to participate in any band activity requied by the Band Director.
Medical Treatment Release:

By signing this form, I give permission for my child to receive emergency medical treatement in case of illness or injury. I further understand that I am responsible for any medical expenses not covered by medical insurance. I agree not to hold Cascade High School, the Cascade High School Band Boosters, the Directors and Staff of the CHS Band, and/or the Bedford County Board of Education responsible for injuries incurred during a band activity.
Insurance Company
Insurance Policy Number
Signature
Parent's Name

First NameLast Name
Emergency Contact Information - Please add in the order of which to be contacted
Date

MonthDayYear
Date
Hour MinutesAM/PM Option
Should be Empty: