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  • EMERGENCY CONTACT (IN ADDITION TO PARENT OR CUSTODIAN)

  • ⭐ REQUIRED INFO -- MUST BE FILLED IN COMPLETELY!!! ⭐

    ⭐ PLEASE UPLOAD A COPY (PDF OR JPEG ONLY) OF STUDENT’S INSURANCE CARD (FRONT ONLY)!!! ⭐
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  • BEFORE you get to the medication entry options "District medication policy permits a responsible, trained student to carry and/or self-administer medication for asthma, severe allergic (anaphylactic) reaction, or diabetes on his/her person for immediate use in a life-threatening situation with written order of licensed provider, parent request, school nurse, and principal approvals." 

    Also, if you would like to arrange to have your child's (or your own) medication held in the band's medical bag, it must have a prescription label on it.

    Here is a form that should be on file with the school in order to carry your medication.
    Medication Administration Request and Consent Form

  • PLEASE SELECT "YES" or "NO" TO THE FOLLOWING MEDICATIONS

  • PLEASE BE SURE TO UPDATE ANY OR ALL INFORMATION ON THIS FORM IF ANYTHING CHANGES.  THIS INCLUDES:

    • INSURANCE INFORMATION
    • MEDICATIONS
    • HEALTH ISSUES   
  • IF MEDICATIONS ARE TAKEN ON A REGULAR BASIS, FILL OUT THE SECTION BELOW (INCLUDE INHALERS):

  • IF MEDICATIONS ARE TAKEN ON AN AS NEEDED BASIS, FILL OUT THE SECTION BELOW:

  • ⭐ REQUIRED INFO--PLEASE FILL OUT COMPLETELY ⭐

  • If your child has a severe allergy or seasonal allergies that might require the need of an epi-pen or medication(s) to treat symptoms, please send epi-pen or medication(s) with your child.

  • If you have any questions or problems completing this form, please let us know at upperdarbyband@gmail.com!

  • Brass, drum, major and woodwinds are required to wear band gloves.

    You get one pair as part of your dues payment and additional gloves are at students cost ($6 per pair).

  • Please Note - State if you are in brass, color guard, drum major, drumline, pit, woodwinds.

    You get one Jacket as part of your dues payment first year and replacement jackets are at students costs of $60. If you don't need a new jacket, leave this section blank.

  • Please Note - Two section shirts are apart of your dues payment.

    Additional shirts are at students cost. Small through Extral Large are $10, 2X is $12 , 3X is $13 and 4X is $14.

  • Please Note - New members get one pair as part of your dues payment.

    What size do you currently wear in a dress shoe or sneaker? Replacement New Shoes—Color Guard and Marching  Band cost $30. If you don't need a pair of replacement shoes, leave this section blank. 

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