Prem1er Community Drumline's              Registration & Releases
For Performance Year 2019-2020
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Email *
CONTACT INFORMATION
Please choose the participant's section *
Participant's Name (First & Last Name) *
Participant Prefers to be called: *
Participant's Parent or Guardian Name *
Participant's Date of Birth *
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Participant's Grade Level *
Mailing Address *
Phone Number *
Emergency Contact Name & Phone Number
PHOTO RELEASE:
Prem1er Community Drumline has a website and other social media accounts where photos and videos from rehearsals and events may be published. It is our policy that photos of children are never published with names or other identifying information. By providing your consent, you hereby grant Prem1er Community Drumline the permission to use your child’s likeness in photographs, video, and other media in any and all of its publications, including social media and website entries. You waive any right to royalties or other compensation arising or related to the use of the photographs or videos.
Please, Choose One: *
GENERAL RELEASES
 “I/We hereby grant permission for my/our child to be a member of the Prem1er Community Drumline and to participate in rehearsals, events and performances arranged by the Director, Mr. Steven Grant, Sr., in this regard from time to time. We recognize the importance of the commitment that he/she makes and that their participation as a part of a larger community calls for responsible behavior. Therefore, I/we agree that if this child engages in behavior which, in the judgment of the staff, is not in the best interest of the trip or event, our/my child or any member of the group may, therefore, be sent home. I/We will assume full legal and financial responsibilities for such a return trip.”

“I/We hereby release from any liability Prem1er Community Drumline and all of its personnel, employees, adult leaders and representatives from any claims for unintended or unexpected accidents which might occur during participation in rehearsals or performances or traveling to or from said events. In granting this permission and release, I/We specifically recognize that my child may from time to time be transported to events by private vehicles operated by members or staff not as agents, employees or representatives. In such regard, I/We specifically release and will hold harmless Prem1er Community Drumline, their officers, volunteers/staff and representatives from any and all liability which may arise as a result of such transportation whether or not organized by Prem1er Community Drumline.”

Type your name below to give consent *
HEALTH INFORMATION & AUTHORIZATIONS
Does this participant have any physical, psychiatric, emotional or behavioral conditions of which the Prem1er Community Drumline should be aware? *
If the answer was yes, please provide the information, below.
Please advise us of any restrictions on activities, if applicable.
Please list any regularly prescribed medications and doses.
Please list any drug allergies.
Does your child require a special diet? If so, Please explain.
This health history is correct. The person herein described has my permission to engage in all prescribed activities except as noted above. Prem1er staff has my permission to administer medications as outlined above. The following authorization empowers the staff of Prem1er Community Drumline to take whatever steps they deem necessary to insure the well being of my child should a medical emergency occur during a rehearsal/performance. Every attempt will be made to contact the child’s care-givers and/or emergency contact provided.I do hereby authorize Prem1er Community Drumline to take necessary emergency measures in the treatment of (participant) if needed. My child is in good physical health and does not have any conditions or disabilities which may be aggravated, except as noted on this form. In the event that I cannot be reached in an emergency, I hereby the authorize the physician selected by Prem1er Community Drumline to hospitalize, secure proper treatment for, and order injections, anesthesia and surgery for my child named above. My typed name serves as my signature of consent. PLEASE TYPE YOUR NAME BELOW. *
CONVENANT
A covenant is an agreement in partnership with God between members of a community. As a participant in the Prem1er Community Drumline activities and trips, I covenant to embody Unity, Purpose, Disciple, Commitment and Excellence. I covenant to be open minded, flexible, and compassionate, showing respect for other people. I also covenant to listen to directions, to be mindful of safety, and to abstain from any behavior that harms or endangers myself, others, or the health of the group. I covenant to speak up about my own needs and to speak to an adult immediately if I feel unsafe or if I witness breaches of covenant.

I understand that when we keep our covenant promises to each other, we co-create with God a safe, life-giving environment in which we are all lifted up. When we break covenant with each other, we break trust and disrupt our ability to operate as a safe and loving community. I understand that should I decide to break this covenant; I may be asked by the staff to leave the rehearsal or event. By signing this covenant, you agree to conduct yourself in accordance with the guidelines of Prem1er Community Drumline. The typed name of the participant serves as their signature of agreement. Any participant under 18 has to have parental or guardian consent. Parents or guardians, please type your name to serve as a signature.

Participant's Name *
Parent/Guardian's Name *
MASTER PERMISSION SLIP
Note: Parents and Guardians will be notified, in advance, about the dates and destinations of all trips.

The Prem1er participant has my permission to attend all rehearsals and to all events with the Prem1er Community Drumline for the 2019-2020 Academic Year and Summer Break, unless I specify otherwise in writing.
PARENTAL INVOLVEMENT
We are striving to provide environment ripe for the success of your child. We need your help! We will be asking for your parental involvement to ensure that your child lives with purpose! Please sign your name below to ensure that you understand that you will be asked to help. Thank-you!
My typed name serves as my signature providing permission for participant involvement. *
Date *
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A copy of your responses will be emailed to the address you provided.
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