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Section 1 of 7
2019 Centennial HS Marching Band Registration
Registration requires completion of:
 ---  2019 Marching Band Intent Form
 ---  Payment of $200 non-refundable deposit
 --- This Google Form
STUDENT Consent, Acknowledgement & Release from Liability
I know of the risks involved in participation in indoor and outdoor physical activities such as traveling to and from Centennial High School Band activities, personal involvement in such activities, including but not limited to practices, marching band camp, trips, competitions, fundraising events, running, swimming and other forms of physical activities and exertion, and the possible presence of insects, reptiles and other wildlife. I understand that serious injury, illness, and even death, are possible in such participation, and choose to accept such risks. I further state there is no medical condition that I have that would prevent me, or increase my risks, from participating in these activities. I voluntarily accept any and all responsibility for my own safety and welfare while participating in these activities, with full understanding of the risks involved. If I have specific conditions, such as heightened sensitivity to insect bites or other medical condition, I shall be responsible for bringing appropriate medication (the handling of which shall be pursuant to Fulton County School guidelines). Should I be 18 years of age or older, or should I be emancipated from my parent(s)/guardian(s), I release and hold harmless Centennial High School and its governing organizations, the Centennial High School Band Boosters, Inc., and those teachers, administrators and parents involved in sponsoring, supervising, chaperoning or otherwise assisting in such activities of any and all responsibility or liability to me or my personal representatives, estate, heirs, next of kin, and assigns for any injury or claim resulting from such participation, whether caused by negligence or otherwise, and agree to take no legal action against any of them because of any accident or mishap involving my participation in any of such activities. I further hereby authorize the use or disclosure of my individually identifiable health information should treatment for illness or injury become necessary. I agree to update my medical form if any medical condition occurs after the date below. I understand that this authorization regarding health information is voluntary and that I may revoke it at any time by submitting the revocation in writing to my school. Furthermore, I grant the released parties the right to photograph and/or videotape me and further to use my name, face, likeness, voice and appearance in connection with exhibitions, publicity, advertising, promotional and commercial materials without reservation or limitation. The released parties, however, are under no obligation to exercise said rights herein. I understand specifically that these activities will include:

- Participation in summer marching band camp and band competitions, including: physical activities, including but not limited to swimming at band camp or other elected trip (pool, lake and/or ocean), calisthenics, physical exercise, marching practices/performances, fundraisers or any other band activity.
- Travel to and from band camp, competitions, football games and other venues to participate in performances of the band.

I/WE HAVE READ THIS CAREFULLY, HAVE FULLY INFORMED MYSELF OF ITS CONTENTS, UNDERSTAND ITS INTENT, AND KNOW IT CONTAINS A RELEASE.

I assume responsibility for my physical condition and capability to perform these activities.

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Student Name
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Student ID Number
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Student Instrument
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Flute
Clarinet
Saxophone
Horn
Trumpet
Baritone
Trombone
Tuba
Percussion
Color Guard
Drum Major
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2019-2020 Grade
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9
10
11
12
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Section 2 of 7
PARENT/GUARDIAN Consent, Acknowledgement & Release from Liability
A. I/we hereby give consent for child/ward to participate in the foregoing activities. I further state there is no medical condition that my child has that would prevent him/her from, or increase his/her risks in, participating in these activities.

B. I understand that activities at Band Camp, competitions, and other venues which the band performs may include swimming activities.

C. I/we further hereby authorize the use or disclosure of my child’s/ward’s individually identifiable health information should treatment for illness or injury become necessary. I/we understand that this authorization is voluntary and that I/we may revoke it at any time by submitting the revocation in writing to my child’s/ward’s school.

D. I/we know of and acknowledge that my child/ward knows of the risks involved in participation in such travel and indoor and outdoor physical activities, including but not limited to swimming and physical exertion; and I/we understand and acknowledge that my child/ward knows that serious injury, illness, and even death, is possible in such participation and choose to accept any and all responsibility for his/her safety and welfare while participating in activities. With full understanding of the risks involved, I/we release and hold Centennial High School and its governing organizations, the Centennial High School Band Boosters, Inc., and those teachers, administrators and parents involved in sponsoring, supervising, chaperoning or otherwise assisting in such activities of any and all responsibility and liability to me or my personal representatives, estate, heirs, next of kin, and assigns for any injury or claim resulting from such participation and agree to take no legal action against any of them because of any accident or mishap involving the participation of my child/ward, whether caused by negligence or otherwise. I further authorize emergency medical treatment for my child/ward should the need arise for such treatment while my child/ward is under the supervision of the school. Furthermore, I grant the released parties the right to photograph and/or videotape my child/ward and further to use said child’s/ward’s name, face, likeness, voice and appearance in connection with exhibitions, publicity, advertising, promotional and commercial materials without reservation or limitation. The released parties, however, are under no obligation to exercise said rights herein.

I/WE HAVE READ THIS CAREFULLY, HAVE FULLY INFORMED MYSELF OF ITS CONTENTS, UNDERSTAND ITS INTENT, AND KNOW IT CONTAINS A RELEASE. I assume responsibility for my child’s physical condition and capability to perform these activities.

My child/ward IS permitted to participate in swimming activities.
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Legal Parent/Guardian 1 Signature
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Legal Parent/Guardian 2 Signature
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As you have read in the Information Packet, volunteers are critical to our successful band program and we ask families to volunteer at least 4 times during the season. There are many different opportunities (some from home, some on location). What sounds interesting to you? Don't worry - we won't limit you to these activities.  
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Leadership - Board position
Fundraising
Hospitality / Social
Communications
Equipment and Transportation
Financials
Making copies or other administrative work
I'm flexible and can help where needed most
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Section 3 of 7
Centennial HS Marching Band Uniform/Rehearsal Information
Students will be fitted for the outer uniform, shoes and shorts during band camp in July. The pants, jacket, gauntlets, gloves and hat are provided by the school and kept at the school. Students are responsible for proper care of their uniform after each use. Specifically, uniform pants and jackets are to be properly hung on their hangers, with pants folded on the crease, and locked in place with the hanger. Students will store gauntlets and gloves in their hat box. Uniforms are cleaned by the Band Booster, as needed.

Students will be given two pairs of gloves and it will be the responsibility of the student to maintain/wash their gloves. Students should keep at least one pair of gloves in their hat box at all times. Students that do not have gloves in good condition (at required time) will be required to purchase a replacement pair ($5).

The under uniform (show shirt, shoes and socks) are kept and maintained by the students.  All under-uniform items should be taken home and washed after each use.  Please note that these items, except for the socks, are specifically ordered for each student.

** Returning students, please check that old shorts and shoes are in good condition and well fitted or order replacements.

Students are expected to have their under-uniform shirts, shorts, gloves, black socks and marching band shoes for each game and competition. In addition, students should bring a refillable water bottle to games, carried in a blue or black string bag. If you like, bottles and string bags with the band's logo are available for sale from the Band's spirit gear store.

To minimize confusion, PLEASE write last names on the inside tags of shorts & shirts and on all water bottles and bags. Since all the marching shoes look alike, please also write their name on the inside of each shoe.

Show Shirts
Each year, a "show shirt" is custom designed that mirrors the theme of our marching band show. Two shirts are provided with your fees, one blue and one black. These are to be worn under the formal outer uniform and should be worn to school every Friday during football season and to any other performances that will require wearing the over uniform. These should NOT BE worn to practice or during other school days.
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T-shirt Size (adult sizes)
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S
M
L
XL
XXL
XXXL
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Marching Shoes
Black shoes made specifically for marching bands are required. Shoes will be fitted and ordered by the band during band camp, cost $40 and should be paid for at the fitting. Shoes are the responsibility of the student and should be brought to school for Friday football games and all performances when the outer uniform will be worn.

Returning students should try on their shoes to ensure they fit comfortably.
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Long Black Socks
Long black socks must be worn at any time marching shoes are worn. Please purchase several pair of mid-calf or higher socks. Centennial Knights branded socks are available from the Band Spirit Gear store on Charms. No ankle socks are allowed. Students that do not have long black socks for performances will be required to purchase a replacement pair ($3).
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On the importance of hydration: A Big Water Bottle
To help ensure proper hydration, students are required to have a ½ gallon water bottle for all rehearsals. Periodic practice breaks allow students time to drink from a nearby source. A half gallon jug with a removable top allows it to be refilled as needed, with plenty of room for ice. This can be purchased for $9 from Amazon or a local big box store.

Students are also expected to bring a smaller bottle to games, carried in a blue or black string bag. If you like, bottles and string bags with our band's logo are available for sale from the Band's spirit gear store.

PLEASE write your name on all equipment.
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Rehearsal Dress Code: White T-Shirts/Dark Shorts
For all outdoor rehearsals, all wind and percussion students are expected to wear white t-shirts and dark shorts. There are two reasons for this (1) white is the coolest color, and (2) setting and cleaning drill is easiest when all students are wearing the same color. Students in the front ensemble are expected to follow this dress code as well, for uniformity and comfort. A six pack of white t-shirts can be purchased from any big box store for $20.
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I agree that I will have a 1/2 gallon water bottle and adhere to the rehearsal dress code at all outdoor practices.
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Section 4 of 7
Centennial HS Band: Student Medical Information
This information is required prior to participation in any marching band activity. Please note that physician-signed physicals are NOT required.
Student Full Name (please use legal name)
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Student Date of Birth
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Parent/Guardian 1 Full Name
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Parent/Guardian 1 "Best Contact" Phone Number
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Parent/Guardian 2 Full Name
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Parent/Guardian 2 "Best Contact" Phone Number
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Primary Home Address (street, city, zip)
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Primary Physician's Name
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Primary Physician's Office Number
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List all known allergies: food, insects, medications, etc. (if none, please state "none")
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List any specific medical problems (if none, please state "none")
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Should your student require a prescription medication to be given during a band sponsored event, the SHS1 form (Authorization to Give Medications) form would need to be filled out and signed by the doctor.
Once the form is completed, submit it to Mr. Ehrlich (ehrlichtl@fultonschools.org.)
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Special Note: If student wants to carry a prescription inhaler, Epipen, insulin, or other approved medication, see below:
To carry approved prescription medication, Fulton County Schools requires you to complete an Authorization to Carry Prescription Medication SRS-2 form. This form is available on your Charms account by clicking on the Handouts & Files Icon. Once completed, email it to Mr. Ehrlich (ehrlichtl@fultonschools.org.)
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Section 5 of 7
Emergency Contact Information
In the event that you cannot be reached, please list at least TWO emergency contacts that are NOT the parents/guardians listed above.
Emergency Contact 1 Name
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Emergency Contact 1 "Best" Phone Number
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Emergency Contact 2 Name
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Section 6 of 7
Registration Process
I understand a $200 non-refundable deposit is required for registration.
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Yes
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add "Other"
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I understand a signed intent form is required for registration.
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Yes
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add "Other"
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I understand updating my Charms profile is required for registration.
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Yes
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Section 7 of 7
Insurance Information
Do you have medical insurance for your student?
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No (If you do not have insurance, it is available from Fulton County Schools (see Front Office) for injuries which may be sustained during practices and/or performances of the Band Program.)
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Insurance Company Name (if none, state "none")
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Policy/Member # (if none, state "none")
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Group Plan # (if none, state "none")
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Carrier Phone # (if none, state "none")
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TO WHOM IT MAY CONCERN: I, the undersigned, being the parent, legal guardian, or legal next of kin of this student, hereby guarantee payment in full for and in consideration of emergency services and goods rendered through the attending physician(s), immediately upon receipt of final billing. Please type your name below as an electronic signature.
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TO WHOM IT MAY CONCERN: I, the undersigned, being the parent, legal guardian, or legal next of kin of this student, hereby grant authorization to the Band Director (s) or any chaperone of the Centennial High School Band Booster, standing in loco parentis (in the event that a parent/guardian cannot be reached by phone), to obtain any medical and/or surgical treatment and procedures from a physician or hospital emergency room physician on behalf of the minor. I also grant permission to administer over-the-counter-medication, as needed. Please type your name below as an electronic signature.
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STUDENT Consent, Acknowledgement & Release from Liability
Student Name
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Student ID Number
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Student Instrument
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2019-2020 Grade
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PARENT/GUARDIAN Consent, Acknowledgement & Release from Liability
My child/ward IS permitted to participate in swimming activities.
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Legal Parent/Guardian 1 Signature
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Legal Parent/Guardian 2 Signature
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As you have read in the Information Packet, volunteers are critical to our successful band program and we ask families to volunteer at least 4 times during the season. There are many different opportunities (some from home, some on location). What sounds interesting to you? Don't worry - we won't limit you to these activities.  
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Centennial HS Marching Band Uniform/Rehearsal Information
Show Shirts
T-shirt Size (adult sizes)
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Marching Shoes
Long Black Socks
On the importance of hydration: A Big Water Bottle
Rehearsal Dress Code: White T-Shirts/Dark Shorts
I agree that I will have a 1/2 gallon water bottle and adhere to the rehearsal dress code at all outdoor practices.
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Centennial HS Band: Student Medical Information
Student Full Name (please use legal name)
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Student Date of Birth
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Parent/Guardian 1 Full Name
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Parent/Guardian 1 "Best Contact" Phone Number
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Parent/Guardian 2 Full Name
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Parent/Guardian 2 "Best Contact" Phone Number
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Primary Home Address (street, city, zip)
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Primary Physician's Name
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Primary Physician's Office Number
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List all known allergies: food, insects, medications, etc. (if none, please state "none")
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List any specific medical problems (if none, please state "none")
No responses yet for this question.
Should your student require a prescription medication to be given during a band sponsored event, the SHS1 form (Authorization to Give Medications) form would need to be filled out and signed by the doctor.
Special Note: If student wants to carry a prescription inhaler, Epipen, insulin, or other approved medication, see below:
Emergency Contact Information
Emergency Contact 1 Name
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Emergency Contact 1 "Best" Phone Number
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Emergency Contact 2 Name
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Emergency Contact 2 "Best" Phone Number
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Registration Process
I understand a $200 non-refundable deposit is required for registration.
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I understand a signed intent form is required for registration.
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I understand updating my Charms profile is required for registration.
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Insurance Information
Do you have medical insurance for your student?
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Insurance Company Name (if none, state "none")
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Policy/Member # (if none, state "none")
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Group Plan # (if none, state "none")
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Carrier Phone # (if none, state "none")
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TO WHOM IT MAY CONCERN: I, the undersigned, being the parent, legal guardian, or legal next of kin of this student, hereby guarantee payment in full for and in consideration of emergency services and goods rendered through the attending physician(s), immediately upon receipt of final billing. Please type your name below as an electronic signature.
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TO WHOM IT MAY CONCERN: I, the undersigned, being the parent, legal guardian, or legal next of kin of this student, hereby grant authorization to the Band Director (s) or any chaperone of the Centennial High School Band Booster, standing in loco parentis (in the event that a parent/guardian cannot be reached by phone), to obtain any medical and/or surgical treatment and procedures from a physician or hospital emergency room physician on behalf of the minor. I also grant permission to administer over-the-counter-medication, as needed. Please type your name below as an electronic signature.
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Relationship to Student
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