Big Mac Band 2019-20 Marching Band Medical Information Form
Welcome to the 2019-20 Big Mac Band! In preparation for marching band season, we ask that you complete this medical form as soon as possible. We will have volunteer medical personnel with the band during practices and performances. They will provide the group with medical coverage and have access to any information that you submit. Be assured that all information provided will be kept confidential and electronic records will be deleted at the end of the school year.

The Canon-McMillan School District and Canon-McMillan High School does NOT permit students to carry non-prescription medications (Tylenol, Advil, cough/cold meds, etc) with them. The medical personnel will have over-the-counter medications available for students on an as needed basis and require the permission of a parent/guardian before administering medication(s) to a student. Please indicate your consent and choice of medications they may administer to your child on this form. The medical personnel will follow the dosage and administration instructions provided on the medication labels.

Students who require prescription medication (inhalers, Epi-Pens, insulin, etc) must remember to bring their medication with them to every practice and performance. All prescription medication MUST be in a container as dispensed by the pharmacist with the student's name clearly printed on it.
Email address *
Student's Last Name *
Your answer
Student's First Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Allergies *
Your answer
What information would you like the medical professionals traveling with the band to know?
Your answer
I give my permission to administer any of the following over-the-counter medications to my child as needed: *
Required
Does your child carry the following: Epi-pen, inhaler, insulin/glucometer, other? Please indicate below.
Your answer
Emergency contact #1(name) *
Your answer
Emergency contact #1(phone) *
Your answer
Emergency contact #2 (name)
Your answer
Emergency contact #2 (phone)
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of CANON MCMILLAN SD. Report Abuse