King Philip Summer Steel Band 2017
First Name
Your answer
Last Name
Your answer
Participant's Home Street Address
Your answer
Town
Your answer
Home Phone
Your answer
Student Email
Your answer
Primary Instrument
Your answer
Grade in School
Mother's/Guardian's First Name
Your answer
Mother's/Guardian's Last Name
Your answer
Mother's/Guardian'sCell Phone
Your answer
Mother's/Guardian's Email Address
Your answer
Father's/Guardian's First Name
Your answer
Father's/Guardian's Last Name
Your answer
Father's/Guardian's Cell Phone
Your answer
Father's/Guardian's Email Address
Your answer
Permission and Discipline Guidelines
I give my son/daughter permission to participate in the Summer Steel Band. I understand there will be trips to perform at the Pan Mass Challenge, Norfolk Community Day, Norfolk Concert on the Common and give permission to my son or daughter to participate on these trips. Information and itineraries will be provided by email when these events arise. Please make a check payable to KPMA for $150 and place in Karen Wolf's mailbox. I also give permission for my son/daughter to travel on a school sponsored bus for King Philip Regional School District Music functions and understand my student must adher to the discipline guidelines in the KPHS Student Handbook.
Required
Signature Name
Your answer
Medical Treatment
Medical Treatment Authorization I hereby give my permission for my son/daughter to participate in all King Philip Regional School District Music Program sponsored activities and functions. My signature below conveys authority for over the counter comfort medication to be dispensed by a designated King Philip chaperone. In case of medical emergency, I understand every effort will be made to contact parents/guardian. In the event I cannot be reached, I hereby give permission to the physician selected by the Director of Music of the King Philip Regional School District to hospitalize, secure proper treatment for, order injections, anesthesia, or surgery for my child. I agree to be responsible for any out-of-pocket expenses or copayments incurred.
Required
Signature Name
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms