Band Student Medical Information 2020-2021
We need accurate medical information on your child in order for them to travel and practice with the marching band.This information will be kept confidential. It will only be shared with the adult who is designated to dispense medications to students. All medications, whether administered by a student or a nurse, must be in the original container. Please instruct your child that they are not to share any medications with their peers. Your student will not be able to participate with us if we do not have this form on file.

                                         Please complete all the information on this sheet. Thank you.
                                                     
                                                   Crawford County High School Marching Band
             400 East Agency Street     Roberta, Ga. 31078     478.836.3126     bruce.fisher@crawfordschools.org
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Student's Full Name *
Parent's / Guardian's Full Name *
Allergies or Conditions of which we need to be aware. Please mark N/A if none. *
Current medications if any. Please mark N/A if none. *
We will have a basic first aid kit with us on our trips. Do we have your permission to administer Tylenot, Motrin, Pepto-Bismol, Benadryl, and / or Dramamine if needed? *
In the event of a medical emergency, I give my permission for my child to be seen by a physician. *
If your answer to the above question was NO, what would you like for us to do?
Please indicate the name of your health insurance company. *
Please enter your policy #  and group # below *
In case of an emergency, please contact the people listed below at the phone number provided. *
Please share with us any additional information we might need in case of an emergency. If not, just answer N/A
Typing your name below will act as your signature. Doing so,verifies that all of the information is accurate and up-to-date. Please type your name and date below. Thank you.
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