PARENT / GUARDIAN CONSENT / RELEASE FORM

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We the parent/guardian of (ENTER STUDENT NAME BELOW) do hereby give our permission for him/her to participate in the Frazier Band and its activities. *

TODAY'S DATE *

YYYY

PARENT/GUARDIAN SIGNATURE *

We do hereby release and forever discharge the Frazier Band Parents Association and designated chaperons from any/all actions or suits in law or equity which we might hereafter have by reasons of injuries sustained by our son/daughter participating in the above mentioned activity. In case of emergency, we give permission for our child to be treated at a hospital and/or by a medical doctor.

IN CASE OF EMERGENCY, CONTACT US AT THIS # *

IF WE ARE UNAVAILABLE, CONTACT (NAME, RELATIONSHIP & PHONE #) *

INSURANCE COMPANY & POLICY # *

PARENT/GUARDIAN SIGNATURE *

NAME OF BAND MEMBER *

HOME PHONE # *

ADDRESS, CITY, ZIP *

AGE *

GRADE *

Does your child have any allergies we need to be aware of? *

Does your child's allergies require him/her to carry an EPI Pen? *

Yes

Does your child's allergies require him/her to carry an Inhaler? *

Yes

If the student will be taking any prescription medication, please list them. *

Can we administer any of the following medications to your child? *

Tylenol

Advil

Benadryl

Cold Medication

Required

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