Creekview HS Band & Guard Information & Consent Forms
Student Last Name *
Your answer
Student First Name *
Your answer
Student Middle Name *
Your answer
Student ID# *
Your answer
Student Email *
Your answer
Student Cell# *
Your answer
Role *
If Instrument Marcher, what instrument do you play?
Your answer
Gender *
Date of Birth *
MM
/
DD
/
YYYY
Grade Level for the 2019-20 school year *
T-Shirt Size *
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Home Phone# *
Your answer
Father's Name *
Your answer
Father's Email *
Your answer
Father's Cell# *
Your answer
Mother's Name *
Your answer
Mother's Email *
Your answer
Mother's Cell# *
Your answer
Student resides with (Names of Parent(s)/Guardian) *
Your answer
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 *
Your answer
Relationship 1 *
Your answer
Phone# 1 *
Your answer
Name 2 *
Your answer
Relationship 2 *
Your answer
Phone# 2 *
Your answer
Health History (check all that apply)
Allergies: please list allergen (insects, food, medications), reaction and treatment
Your answer
Please check each medication you authorize to be given as needed
Any other health history (please explain below)
Your answer
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. *
Your answer
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