Medical Release Form
TOMBALL INDEPENDENT SCHOOL DISTRICT/Tomball Memorial High School Choir
2020-2021 STUDENT CONTACT INFORMATION AND MEDICAL RELEASE FORM
Form Information
Dear Parent/Guardian:
Occasionally choir events will require that your child travel off campus. To be able to do so, you must complete the form below and return it to the event sponsor. We must have this completed form on file before your student will be allowed to travel or participate in extracurricular choir activities.
Contact Information
Student LAST Name *
Student FIRST Name *
Grade *
Gender *
Date of Birth *
MM
/
DD
/
YYYY
Home Phone / Parent Phone *
Street Address *
City *
Zip *
Parent/Guardian 1 NAME *
Parent/Guardian 1 PHONE *
Parent/Guardian 1 EMAIL ADDRESS *
Parent/Guardian 2 NAME
Parent/Guardian 2 PHONE
Parent/Guardian 2 EMAIL ADDRESS
Alternate Emergency Contact
Emergency Contact NAME *
Emergency Contact PHONE *
Student Medical Information
Insurance Provider *
Policy # *
Existing Medical Conditions
Date of Most Recent Tetanus Booster *
MM
/
DD
/
YYYY
Allergies
Medications Taken Routinely
Special Considerations
Authorization for Participation
My child, NAMED ABOVE, has my permission to participate in ALL TMHS CHOIR ACTIVITIES.

SPONSORS:‚Äč Jed Ragsdale, Kimberly Dillow

I, the undersigned, do hereby authorize officials of the Tomball I.S.D. to contact persons named on this form in the event of illness, injury, and/or inappropriate behavior of my child. If I or persons named on this sheet cannot be reached, T.I.S.D. school officials are hereby authorized to take whatever action is deemed necessary in their judgment, for the health and safety of said child. I realize that this form does not abrogate or modify my rights as a parent/guardian of a minor. I have voluntarily signed this form to facilitate and expedite the treatment of my child. I will not hold the Tomball I.S.D. or the school official(s) financially responsible for the emergency care and/or transportation of said child.
Parent E-Signature *
I understand that typing my name in the box below gives Authorization for Participation as stated above.
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