SPHS Choir Student Contact Information & Medical Consent Form
This form must be completed by all SPHS Choir students AND parents. Typed names on this document will serve as signed consent from both the student AND the parent.
Student ID Number
Student Last Name
Student First and Middle Name
Parent/Guardian #1 Name (First & Last)
Parent/Guardian #1 Phone #
Parent/Guardian #1 Email Address
Parent/Guardian #2 Name (First & Last)
Parent/Guardian #2 Phone #
Parent/Guardian #2 Email Address
Student Cell Phone Number
Student Email Address
9 - Freshman
10 - Sophomore
11 - Junior
12 - Senior
T-Shirt Size (adult sizes)
In which choirs are you enrolled?
1st Period: Varsity Men
3rd Period: Chorale
4th Period: Chamber Choir
5th Period: Concert Women
7th Period: Varsity Women
Emergency Contact Name (First & Last)
Emergency Contact Relationship
Emergency Contact Primary Phone #
Emergency Contact Secondary Phone # (if applicable)
Emergency Contact Address
Emergency Contact Zip Code
Emergency Contact Email Address
Does your student have any medical conditions or is he/she under any medication?
If yes, please explain:
Please list any allergies:
Insurance Policy Holder Name
Insurance Policy Number
Insurance Group Number
Insurance Company Phone #
Doctor's Phone #
In the event I cannot be reached in an emergency, I give permission to the Choir Directors and/or authorized personnel to secure the proper treatment for my student. (Please type Parent/Guardian #1's Name & Relationship)
In the event I cannot be reached in an emergency, I give permission to the Choir Directors and/or authorized personnel to secure the proper treatment for my student. (Please type Parent/Guardian #2's Name & Relationship)
A copy of your responses will be emailed to the address you provided.
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