2019-2020 Land O' Lakes High School Gator Band

Dear Land O' Lakes HS Band Members and Parents,

I am looking forward to an exciting year with the LOLHS Band program. The purpose of this form is to collect all pertinent information of your student for participation in the band. All band students (winds, percussion, and guard) must complete this online form by Wednesday August 14th. Please be sure all information entered is correct before submitting.

All details on eligibility, qualifications, and policy can be found in the band handbook here on the website. All band students must return the signed handbook slip as well. If you have any questions please contact the band director, Mr. Mulder.

The Land O' Lakes HS Band has a tradition of musical excellence, which is achieved through a high level of commitment and dedication from our band members, administration, and volunteers. By completing the agreement at the end of this form you are signifying that all information entered is correct and agree to the district release form.

I'm looking forward to a great year of music and success with all of you!

Sincerely,

Mr. Johnathon Mulder
Director of Music

Student Name Student Name * First Last
Student ID Number *
Must be 6 digits. Currently Entered: 0 digits.
Date of Birth Date of Birth * / MM / DD YYYY
Grade *
Home Address Home Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Home Phone Home Phone * - ### - ### ####
Parent/Guardian Parent/Guardian * First Last
Main/Cell Phone Number Main/Cell Phone Number * - ### - ### ####
Email *
Parent/Guardian Parent/Guardian First Last
Main/Cell Phone Number Main/Cell Phone Number - ### - ### ####
Email
Person who will care for student in case parent/guardian cannot be reached: they have permission to take the student from school or chorus event. Person who will care for student in case parent/guardian cannot be reached: they have permission to take the student from school or chorus event. * First Last
Emergency Contact/Caregiver's phone number Emergency Contact/Caregiver's phone number * - ### - ### ####
Person who will care for student in case parent/guardian cannot be reached: they have permission to take the student from school or chorus event. Person who will care for student in case parent/guardian cannot be reached: they have permission to take the student from school or chorus event. First Last
Emergency Contact/Caregiver's phone number Emergency Contact/Caregiver's phone number - ### - ### ####
Persons who may not legally contact or remove my student from school or chorus event.
List and medications your student is currently taking at home or school.
List any health problems or allergies.
I authorize the District to use, in perpetuity, my student's likeness, voice, or performance which has been recorded on a device or other media. Such use shall include, but not limited to the following areas: instruction, general education purposes, entertainment, or the promotion of the chorus. *

I authorize the District to use, in perpetuity, my student's likeness, voice, or performance which has been recorded on a device or other media. Such use shall include, but not limited to the following areas: instruction, general education purposes, entertainment, or the promotion of the chorus. Yes No
District School Board of Pasco County Parent Release

In consideration of my student having been accepted by the principal, teacher(s), or other personnel of LOLHS and the District, to participate is all school-sponsored field trips and activities associated with the Chorus Program.
Transportation by: *

Transportation by: School Bus/Van Private Vehicle Charter Bus Walking

Select all to approve transportation by all methods for the entire school year.
I, the undersigned, understand that my child, if transported by a privately owned vehicle, charter bus, school bus or walking, hereby release the District School Board of Pasco County, the individual members of said Board, the Superintendent, the principal, teachers or other employees of the school, and volunteer leaders from any financial responsibility because of sickness of the student while going to, returning from, or attending said field trip or because of any accident in which the student is injured. To ensure prompt attention in case of sickness or accident, I hereby authorize the person(s) in charge of said trip to incur expense considered necessary for treatment, and I agree to pay for same if this is in excess of the amount paid by any accident or health insurance policy that may be in effect at the time of the sickness or accident.
In any situation in which the safety and security of students might be compromised (i.e., Red Alert Status issued by the Department of Homeland Security, severe weather conditions, etc.) the District School Board of Pasco County will take the necessary steps to ensure the safety of its students and staff, including the cancellation of scheduled field trips and school events. Should this trip or event be cancelled as a result of such an event, the District cannot guarantee any monies (including deposits) will be refunded by the vendor(s) associated with this transaction. Therefore, students, parents, guardians, etc., are hereby cautioned and advised that the District will not be liable for any reimbursements associated with this event that are not refunded by the vendor(s) and returned to the District.

PARENT/GUARDIAN SIGNATURE: Draw your signature into the box below. Use your mouse, finger on a touchpad, or finger on a tablet to sign this form. *

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
By checking the box below and signing the signature pad, I agree to the statements above. *

By checking the box below and signing the signature pad, I agree to the statements above. Agree
Date Date * / MM / DD YYYY

2019-2020 Land O' Lakes High School Gator Band

2019-2020 Land O' Lakes High School Gator Band

District School Board of Pasco County Parent Release