Marching Band Participant Information Form
Sign in to Google to save your progress. Learn more
Student Last Name *
Student First Name *
Grade Level for NEXT YEAR *
2017-2018 School Year
Instrument to be played in Marching Band *
Parent/Guardian Name #1 *
Parent/Guardian Name #2 *
Parent Emergency Contact Number *
Emergency Contact Name (other than parent/guardian) *
Emergency Contact's Phone Number *
Student's Primary Care Physician *
Primary Care Physician's Phone Number *
Health Insurance Provider *
(i.e. Anthem, Southern Health, etc.)
Primary Name on Insurance *
Insurance Policy Number *
Insurance Co. Phone Number *
(usually an 800 number listed on the back of your insurance card)
Does the student have an medical conditions we should be aware of? *
Please type "none" if none exist.
Please list any allergies the student may have. *
Please type "none" if none exist.
Please list any medication that the student takes on a regular basis. *
Please type "none" if none exist.  Please note if the student is permitted by HCPS  carry an epi-pen or inhaler with them.
Please let us know if you as a parent/guardian have any of the below skills that you would be willing to share our band program.
Clear selection
Would you be interested in selling Hawk Cards? *
These are fundraiser cards (sold for $10.00 each) for the Mechanicsville area that allow students to receive $5.00 towards trip expenses/other band fees.
If you would like to sell Hawk Cards, how many shall we reserve for you? *
Sales will start in August.
How many tickets would you like for us to provide you to buy/sell for our end of the year celebration breakfast at Applebee's at VCC? *
We are asking for all current and rising band students to sell at least 4 tickets to our first of hopefully many fundraising ventures with Applebee's @ VCC on June 10th.  They are hosting a breakfast solely in our honor, with proceeds benefiting our program.  Tickets are $10.00 each and include eggs, pancakes, sausage, beverage and service to your table.  Unsold tickets may be returned without penalty by June 1st.
What size t-shirt would you like us to order you? *
All sizes are adult sizes.
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms