CSHS Choir Travel & Medical Release Form
1. My son/daughter has my permission to travel to and from, and participate in:
a. Activity: all College Station High School Choir activities during the school year.
b. Location: both at and away from school, to be announced
2. My son/daughter has assured me that he/she will conduct himself/herself in an appropriate manner that reflects positively on College Station I.S.D.
3. I understand that students will be chaperoned while on any school trip by director and parent chaperones.
4. I also authorize the College Station ISD representative to:
a. Represent me before any medical institution where it may be necessary to send my son/daughter while under their care.
b. Give in my name the necessary authorization for surgery in case of emergency, when medical authorities deem it indispensable.
c. Represent me while my son/daughter is under their custody.
Student Last Name *
Student First Name *
Choir *
Required
Birthday: *
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Parent / Guardian's Names *
Address *
City + Zip Code *
Home Phone *
Father's Work Phone *
Father's Cell Phone *
Mother's Work Phone *
Mother's Cell Phone *
Alternate name to contact in case of emergency *
Relationship to student *
Alternate contact's phone # *
Name of Physician *
Physician's Phone # *
Important Medical Information (drug or food allergies, special medical conditions, medications, etc) *
Date of last Tetanus Shot *
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Please scan & email to ketheredge@csisd.org or send a copy of your student's Insurance Card. *
Required
I have read and agree to the above Permission to Travel & Medical Release. (Please type your name & email below to certify this information.) *
Today's Date *
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