School Band Release and Consent
Formerly SCPS Medical Release Form
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Email *
Student Last Name *
Student First Name *
Allergies/Medication/Medical Info *
Medical Insurance Company *
Group/Policy Number *
Insurance Phone Number *
Student's Physician *
Physician Address *
Physician Phone Number *
Parent/Guardian Name *
Home Address *
Parent/Guardian Phone Number *
Parent/Guardian Work Number
Emergency Contact *
Emergency Contact Phone Number *
For the time period of 5/31/2024 to 6/1/2025

I/We hereby give my son/daughter permission to travel with the Lyman High School Band/Color Guard on all trips and functions during the year.  I/We hereby authorize emergency medical treatment for this person for the time period listed above.  I/We acknowledge that the Seminole County Public Schools (SCPS) is not liable for medical expenses, hospital expenses, or other such charges incurred for such services as may be rendered for or on behalf of my/our son/daughter as a result of injury or sickness.  I/We understand that if my/our son/daughter is injured or becomes sick SCPS will not be liable unless the injury or illness is the result of negligent conduct on the part of an employee of SCPS.  I/We will assume financial responsibility for the incurred expenses through the insurance company listed in this document.
 *
Required
I/We hereby authorize band volunteer personnel to administer Tylenol, Advil, Antihistamine (or equivalents), Imodium, Tums, topical Benadryl or hydrocortisone cream to my child for treatment of minor headaches, aches/pains or insect bites as associated with afterschool practices/games/concerts/trips/parades.  Dosage will be given per label instruction. *
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