SPIRIT OF THE SANDS BAND REGISTRATION FORM 2017-2018
WELCOME TO THE SPIRIT OF THE SANDS!! In order to reduce paper waste and preserve privacy, we have initiated this ONLINE REGISTRATION FORM. All students planning on being involved with the instrumental program. This must be completed by Parents/ Guardians although students may assist in the entering of information. Please complete the following completely and thoroughly. Thank you for your cooperation.
FIRST NAME
Your answer
Last Name
Your answer
HOME PHONE
Your answer
ZIP
Your answer
GRADE IN 2017-2018
SPIRIT OF THE SANDS GROUP(s)
(Please check all that apply)
Required
STUDENT ADDRESS
Your answer
STUDENT EMAIL
Your answer
CITY
Your answer
PRIMARY INSTRUMENT (includes FLAG)
Your answer
OTHER INSTRUMENT(s)
Your answer
STUDENT MOBILE PHONE
(if applicable)
Your answer
PARENT 1/ GUARDIAN NAME
Your answer
PARENT 1 PLACE OF EMPLOYMENT
Your answer
OCCUPATION
Your answer
LIVES WITH STUDENT
PARENT 1 MOBILE PHONE
Your answer
PARENT 1 EMAIL (if applicable)
Your answer
PARENT 2/ GUARDIAN NAME
Your answer
PARENT 2 PLACE OF EMPLOYMENT
Your answer
OCCUPATION
Your answer
LIVES WITH STUDENT
PARENT 2 MOBILE PHONE
Your answer
PARENT 2 EMAIL (if applicable)
Your answer
STUDENT T-SHIRT SIZE
NOTE: ADULT SIZES
AUTHORIZATION:
Understanding that all activities undertaken by the PALM SPRINGS HIGH SCHOOL INSTRUMENTAL MUSIC DEPARTMENT are designed to have educational and/or cultural value, I therefore give my permission for my son/daughter to participate in all rehearsals, performances, and activities approved and undertaken by the school and Palm Springs High School Band Booster Association. In the event of illness or injury, I do hereby consent and will assume financial responsibility to whatever x-ray, examination, anesthetic, medical, surgical, or dental diagnosis or treatment and hospital care are considered necessary in the best judgment of the attending physician, surgeon, or dentist and performed under the supervision of a member of the medical staff of the hospital or facility furnishing medical or dental services. I understand that I will be notified by the Band Director or appointed representative as soon as possible. As stated in the California Education Code Section 35330, I understand that I hold Palm Springs Unified School District, its officers, agents, and employees, harmless from any and all liability or claims, including bodily injury, which may arise out of or in connection with my child's participation in this activity. I fully understand that participants are expected to conduct themselves in a reasonable and responsible manner while participating in Band or Visual Corps activities. Serious violation of rules or regulations may result in the individual being sent home at parent's expense. BY ENTERING MY NAME BELOW I AM SIGNIFYING I AM THE PARENT OR LEGAL GUARDIAN OF THE STUDENT NAMED ABOVE AND HEREBY CONSENT TO THIS AUTHORIZATION. (ENTER PARENT NAME)
Your answer
DATE (mm/dd/20yy):
Your answer
PERFORMANCE TRAVEL CONSENT
As a member of the Palm Springs High School Band I understand and accept responsibility for my child to travel to and/or from performances published as “own transportation”. I do hereby give my consent to allow my child to drive to “own transportation” events should they be licensed and/or accept responsibility to find alternate transportation. The above student hereby requests permission to provide his/her own transportation at his/her own expense. IF THE STUDENT PROVIDES HIS/HER OWN TRANSPORTATION, IT IS FULLY UNDERSTOOD THAT THE DISTRICT IS IN NO WAY RESPONSIBLE, NOR DOES THE DISTRICT ASSUME LIABILITY, FOR ANY INJURIES OR LOSSES RESULTING FROM THIS NON-DISTRICT SPONSORED TRANSPORTATION. ALTHOUGH THE DISTRICT MAY ASSIST IN COORDINATING TRANSPORTATION AND/OR RECOMMEND TRAVEL TIME, ROUTES, OR CARAVANNING TO OR FROM THIS EVENT. I FULLY UNDERSTAND THAT SUCH RECOMMENDATIONS ARE NOT MANDATORY. I ALSO UNDERSTAND THAT IF I RIDE WITH ANOTHER PERSON, THE DRIVER IS NOT DRIVING AS AN AGENT OF OR ON BEHALF OF THE DISTRICT.
Your answer
DATE (mm/dd/20yy):
Your answer
AUTHORIZATION TO PHOTOGRAPH:
I hereby authorize the Palm Springs Unified School District and Palm Springs High School Band Booster Association full and absolute permission to take, or contract with others to take, photographs, videotapes, or other mechanical production of my child, minor of whom I am the legal guardian in an educational or cultural environment. Such photographs or recordings may be published in any media form by the Palm Springs Unified School District or Palm Springs High School Band Boosters for educational and/or public information purposes without compensation or liability from such use. BY ENTERING MY NAME BELOW I AM SIGNIFYING I AM THE PARENT OR LEGAL GUARDIAN OF THE STUDENT NAMED ABOVE AND HEREBY CONSENT TO THIS AUTHORIZATION TO PHOTGRAPH. (ENTER PARENT NAME)
Your answer
MEDICAL HISTORY
Please check all that apply:
Required
Additional Information
Your answer
Are there ANY medical conditions that could affect Band or Flag Participation?
If YES, please describe
Your answer
ALL medications used by students must be registered on this form.
Please list any and all medications used by the student.
Your answer
Medical Insurance Carrier
Your answer
Medical Insurance Policy Number:
Your answer
Medical Insurance Phone Number:
Your answer
BAND HANDBOOK
I have read and understand the band handbook (http://www.psband.org/Spirit_of_the_Sands/Handbook_1_main.html) outlining requirements for participation in the Spirit of the Sands including Policies and Expectations. I further understand and agree that the above information will become part of a student file. I certify that the above information is correct, and I agree to notify the Band Office immediately should any information change that might affect student participation. BY ENTERING MY NAME BELOW I AM SIGNIFYING I AM THE PARENT OR LEGAL GUARDIAN OF THE STUDENT NAMED ABOVE AND HEREBY CONSENT TO THIS AUTHORIZATION TO PHOTGRAPH. (ENTER PARENT NAME)
Your answer
IF YOU REQUIRE ADDITIONAL INFORMATION PLEASE VIST THE OFFICIAL BAND WEBSITE AT: psband.org IF YOU REQUIRE ADDITIONAL ASSISTANCE OR HAVE INQUIRIES, PLEASE ENTER YOUR QUESTION HERE.
Your answer
INSTRUMENT REGISTRATION
Do you own your own instrument
If YES, please supply the make or manufacturer of the instrument
(must supply if school instrument or see Mr Ingelson)
Your answer
If YES, please supply the SERIAL NUMBER of the instrument
(must supply if school instrument or see Mr Ingelson)
Your answer
Please provide a BRIEF DESCRIPTION of the instrument case
(ie. color of case, any distinguishing stickers, marks, etc.)
Your answer
What Instrument do you play?
Your answer
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