2020 Creekview Winter Guard Information & Consent Form
Student Last Name *
Student First Name *
Student Middle Name *
Student ID# *
Student Email *
Student Cell# *
Gender *
Date of Birth *
MM
/
DD
/
YYYY
Grade Level for the 2020-21 school year *
Street Address *
City *
State *
Zip *
Home Phone# *
Father's Name *
Father's Email *
Father's Cell# *
Mother's Name *
Mother's Email *
Mother's Cell# *
Student resides with (Names of Parent(s)/Guardian) *
Emergency Contact Information
In an event the father or mother cannot be reached, these persons should be contacted regarding any situations which any officer, agent, or employee of the Cherokee County School District finds to be an emergency involving the student.
Name 1 *
Relationship 1 *
Phone# 1 *
Name 2 *
Relationship 2 *
Phone# 2 *
Health History (check all that apply)
Allergies: please list allergen (insects, food, medications), reaction and treatment
Please check each medication you authorize to be given as needed
Any other health history (please explain below)
In case of a serious illness/injury, the Creekview High School Band personnel will telephone emergency medical services (911) for immediate transportation to the closest hospital.
By entering your electronic signature below, you authorize the transportation of and treatment by the hospital emergency staff for my child. *
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