NOT SIGNED/INCLUDED as my student does not self-administer medicine

Transcription

1 School Year Hello, and welcome to Ridge Point High School Band and Guard! The attached forms help us manage and support the more than 170 members of the Band and Guard. Please sign and return all of the forms, including this cover page, to the lock box in the band hall, mail them to our PO Box below, or scan and the packet to Student Name: I have included: Band/Guard Member Information Sheet FBISD Medical Information Certificate Signed by a Parent/Guardian FBISD Parent-Physician Permit to Carry (if your student self-administers medicine) - OR - NOT SIGNED/INCLUDED as my student does not self-administer medicine Signed by a Parent/Guardian -AND- Signed by Physician Student Medications Form (for allowing Chaperones to administer medication to students) Signed by a Parent/Guardian Parent/Student UIL Marching Band Acknowledgement Form Travel Consent Form Photo Authorization Form Signed by a Parent/Guardian -AND- Signed by Student Signed by a Parent/Guardian Signed by a Parent/Guardian Fees Form (return either Band or Guard form as appropriate) My check is enclosed -OR- I paid online

2 School Year Band / Guard Member Information Sheet PLEASE PRINT LEGIBLY Student Name: Student Address: City: Zip: Student Cellphone #: ( ) - Student Student t-shirt size (circle one): S M L XL XXL XXXL Parent / Guardian #1: Name: Relationship: Cellphone #: ( ) - Please sign this up to receive the RP Band & Guard Newsletter Parent / Guardian #2: Name: Relationship: Cellphone #: ( ) - Please sign this up to receive the RP Band & Guard Newsletter Other Family Member: Name: Relationship: Cellphone #: ( ) - Please sign this up to receive the RP Band & Guard Newsletter

3 FORT BEND I.S.D. MEDICAL INFORMATION CERTIFICATE PLEASE PRINT Student's Name: Last First Middle Campus: Age: Date of Birth: / / Grade: Sex: M F Student ID #: (Circle One) Address: Street City State Zip Code Subdivision: Home Phone Number: ( ) - Name of Physician: Physician s Telephone: ( ) - Medical Health Insurance Coverage: YES / NO If YES, What Type: HMO / PPO / OTHER Insurance Company: Policy Number: Group: Emergency Contact Parent(s)/Guardian(s): Father s Work Phone: ( ) - Father s Cell Phone: ( ) - Father s Place of Employment: Mother s Work Phone: ( ) - Mother s Cell Phone: ( ) - Mother s Place of Employment: Father Medical History: Allergies Allergy to medication Asthma Bleeding tendencies Bone and/or joint injury or disease Contact Lenses/Glasses Diabetes Eye, Kidney, Lung removed/nonfunctioning Heart Disease Hernia Is student taking medication regularly? Mother Yes No Yes No High Blood Pressure Hepatitis Kidney Disease and/or injury Neck injury Rheumatic Fever Seizures, concussion, loss of consciousness Sickle Cell Anemia Skin Disease Surgical operation Tuberculosis Is student currently under a physician's care? Date of last tetanus shot? Explain any "yes" answers, please explain: Please list all medications and any illnesses not listed above requiring medication being taken at the present time. I hereby consent for medical care to be given to in case of an emergency. Signature of Parent/Guardian Please return this form to your child s teacher of record. Date This form must accompany the student on all school trips.

4 FORT BEND INDEPENDENT SCHOOL DISTRICT Parent-Physician Permit to Carry Asthma and Anaphylaxis Emergency Medication Student Grade DOB Teacher (for elementary use) Allergies Medication Strength Dose Frequency as needed or scheduled time: Start date to be given: End date to be given: (Valid for current school year only) Number of pills or tablets Expiration date of medication Reason student is receiving medication: Possible reactions or restrictions: My student is capable of self-administration of the above medicine. I authorize my student to self-administer this emergency medication according to doctor s orders while on school property or at a school-related event or activity. I understand that my student is responsible for the proper handling and carrying of this medication and that it must be kept out of the reach of other students at all times. The medication must have a current prescription label indicating that it has been prescribed for my student. The school nurse has my permission to consult Dr. medication. with questions regarding this Parent/Guardian Signature Date Home Phone # Daytime phone # Comments: This student has demonstrated the knowledge and skill level necessary to self-administer this medication and in my professional opinion, this student should be allowed to carry this emergency medication/inhaler as well as to self-administer and manage his/her emergency treatment while at school or school related events. Physician s Name (Print) Telephone # Fax # Physician s signature Date Med consent Updated 4/2012

5 School Year Student Medications Form STUDENT NAME: Procedure for Student Medication On Band Trips If your child takes medication on a regular basis, his / her medication(s) will be administered by RPHS Band and Guard Chaperones at their usual time(s) while on Ridge Point Band and Guard trips during the school year. Please send your child s medication to school in a sealed plastic bag, labeled with the student s name and include this signed permission slip. All medications MUST be in the original container and indicate your child s name. We will have a first aid kit supplied with Advil and Tylenol available for headaches, pain, or fever. Please sign the consent form below if you wish this OTC medicine to be available to your child. Parental Permit to Administer Medication Please print: I (parent/guardian), consent to my child receiving if necessary for pain or fever: (please check for consent): Advil Tylenol Sudafed Benadryl Cough Drops Cough Syrup Tums Pepto Bismol Other Medications: Medication: Time(s) to be given: Amount to be given: Reason for Medication Second Medication: Medication: Time(s) to be given: Amount to be given: Reason for Medication Please list additional medications below: Parent / Guardian Signature Date

6 Student Name PARENT/STUDENT UIL MARCHING BAND ACKNOWLEDGEMENT FORM No student may be required to attend practice for marching band for more than eight hours of rehearsal outside the academic school day per calendar week (Sunday through Saturday). This provision applies to students in all components of the marching band. On performance days (football games, competitions and other public performances) bands may hold up to one additional hour of warm-up and practice beyond the scheduled warm-up time at the performance site. Multiple performances on the same day do not allow for additional practice and/or warm-up time. Examples Of Activities Subject To The UIL Marching Band Eight Hour Rule. Marching Band Rehearsal (Both Full Band And Components) Any Marching Band Group Instructional Activity Breaks Announcements Debriefing And Viewing Marching Band Videos Playing Off Marching Band Music Marching Band Sectionals (Both Director And Student Led) Clinics For The Marching Band Or Any Of Its Components The Following Activities Are Not Included In The Eight Hour Time Allotment: Travel Time To And From Rehearsals And/Or Performances Rehearsal Set-Up Time Pep Rallies, Parades And Other Public Performances Instruction And Practice For Music Activities Other Than Marching Band And Its Components NOTE: An extensive Q&A for the Eight Hour Rule for Marching Band can be found on the Music Page of the UIL Web Site at: We have read and understand the Eight-Hour Rule for Marching Band as stated above and agree to abide by these regulations. Parent Signature Date Student Signature Date This form is to be kept on file by the local school district.

7 School Year Travel Consent Form As a member of the Ridge Point High School Band and Guard: Student Name Grade Permission to Travel The above-named student has my consent to travel to and / or from all activities beginning August 1 of the above school year and ending by July 31 of the same school year, including all errands and activities related to these events. The mode of transportation may be by airplane, FBISD or commercial bus, or FBISD Van driven by district employee. I understand that the student will be chaperoned / supervised while in route to or while participating in activities. Students, even though off-campus, are still subject to all school rules and regulations when participating in Ridge Point Band and Guard activities. I understand that any student who does not conduct himself/herself properly may be (1) sent home at the parent s expense, (2) prohibited from participating in future activities of this organization, and (3) subjected to other appropriate disciplinary measures. I agree to, and hereby release Fort Bend Independent School District and its trustees, employees, sponsors and volunteers from all legal responsibility from liability resulting from any activities of this organization, including liability caused by or related to the negligence of any such party. In case of emergency and with the approval of the sponsor or another FBISD employee, I give my approval and authorization for the first aid treatment and any medical treatment by local physicians and/or hospital including surgical procedures. I agree to accept responsibility for payment of all charges incurred during this medical treatment. Additional medical information will be on file with the faculty sponsor in case of an emergency. Please make sure the information on the FBISD Medical Information Certificate is current and on file with the Ridge Point High School Band and Guard. Compliance with the above-described restrictions will be the responsibility of the Student and not FBISD or any of its agents, trustees, volunteers, or employees. The student understands the above restrictions and agrees to comply with the same. Noncompliance shall be grounds for dismissal from the organization. My son / daughter has assured me that he / she will conduct himself / herself in such a manner that good credit will be reflected upon the school. Itineraries will be available for every event and students will need to be picked up promptly following the estimated return time. Both my child and I understand that all Fort Bend ISD policies are in place during any band event regardless of its location or time. I have read and agree to the above listed travel sections: Signature of Parent / Guardian: Date:

8 RPHS BAND and COLOR GUARD As your student participates in the RPHS Band and Color Guard program during the school year, pictures and/or videos may be taken so that they can be posted to our website and/or to other forms of authorized media being utilized by the RPHS Band and Guard Authorization to Post Band and Color Guard Photos Band and Color Guard Season By signing below, you AUTHORIZE permission to post pictures, videos, name, and grade of your student to the Ridge Point Band website (and/or other authorized media, such as Facebook or Twitter) in connection with his/her participation in RPHS Band and Color Guard.* Band/Guard Member's Name (please print) Parent/Guardian Signature* Date * Signature indicates an understanding that the website/media has a large audience and a student s photo will be available to the general public. RPHS Band Booster Club assumes no liability or responsibility whatsoever concerning any consequences of such use. Person signing attests the right to give this permission. If parent/guardian gives written notice to the president or webmaster of the Ridge Point Band that they object to any particular picture on the website, it will be removed as soon as possible. Supporting the functions of the Ridge Point High School Band and Color Guard Ridge Point Band Boosters is a 501(c)(3) organization Ridge Point Band Boosters, 9119 Highway 6 South, Suite # , Missouri City, TX info@rpband.org

9 School Year Marching Band Fees Student Last Name: Student First Name: A non-refundable deposit of $100 is due by May 19, The balance is due in full on July 19, Post-dated checks must be turned in or an installment plan must be set up on Pay Pal by May 19. Freshmen and New Members will need the first four items, as well as gloves if they are not percussion. Returning members only need the first item, plus any other item that they need to replace. Freshman / Returning Fees Amount New Member Member Band Member Fair Share (includes show & sponsor shirts, meals, In-State marching competition trip) Marching shoes Water jug Logo shorts Gloves required for brass & woodwind, set of Optional extra show shirt Optional extra sponsor shirt Optional gluten-free meals Optional vegetarian meals Percussion shirt (required for percussion members) Jazz Band (required for Jazz Band members) Total due: If you would like to be considered for a scholarship to help cover these fees, please contact Lisa Landry in confidentiality by May 19, 2017: lisalandrytx@gmail.com or May 19, 2017: Turn in this form; Non-refundable deposit of $100; Post-dated payments; Scholarship request for help due. June 19, 2017: Second payment of $200 will be deposited on or after this date. July 19, 2017: Final Payment of $200 or remaining balance will be deposited on or after this date. Make checks payable to RPBB. Deliver to lockbox in band hall when band is open or mail to RPBB, 9119 Highway 6 South, Suite 230, #131, Missouri City, TX 77459, or pay online at rpband.org (convenience fees apply) - this form must still be turned in. I have read the Estimated Fees sheet and the due dates for the Ridge Point High School Band fall and spring programs. I understand that I am financially responsible for these fees and will have them paid according to the published due date unless otherwise arranged with the Director of Bands and the RPBB Treasurer. I understand that there will be no refund after September 1. Cancellations must be in writing to rpband.org by 9/1/17. Person responsible for Payment: Name: Signature: Date: Address (for payment questions):

10 School Year Color Guard Fees Student Last Name: Student First Name: A non-refundable deposit of $100 is due by May 19, The balance is due in full on July 19, Post-dated checks must be turned in or an installment plan must be set up on Pay Pal by May 19. Freshmen and New Members will need the first nine items. Returning members only need the first item, plus any other item that they need to replace. Freshman / Returning Fees Amount New Member Member Guard Member Fair Share (includes show & sponsor shirts, meals, In-State marching competition trip) Performance shoes Water jug Band Logo shorts Body Tights Jazz Pants Jacket Gloves Bag Optional - extra show shirt Optional - extra sponsor shirt Optional - gluten-free meals Optional - vegetarian meals Total due: If you would like to be considered for a scholarship to help cover these fees, please contact Lisa Landry in confidentiality by May 19, 2017: lisalandrytx@gmail.com or May 19, 2017: Turn in this form; Non-refundable deposit of $100; Post-dated payments; Scholarship request for help due. June 19, 2017: Second payment of $200 will be deposited on or after this date. July 19, 2017: Final Payment of $200 or remaining balance will be deposited on or after this date. Make checks payable to RPBB. Deliver to lockbox in band hall when band is open or mail to RPBB, 9119 Highway 6 South, Suite 230, #131, Missouri City, TX 77459, or pay online at rpband.org (convenience fees apply) - this form must still be turned in. I have read the Estimated Fees sheet and the due dates for the Ridge Point High School Band fall and spring programs. I understand that I am financially responsible for these fees and will have them paid according to the published due date unless otherwise arranged with the Director of Bands and the RPBB Treasurer. I understand that there will be no refund after September 1. Cancellations must be in writing to rpband.org by 9/1/17. Person responsible for Payment: Name: Signature: Date: Address (for payment questions):

11 Ridge Point High School Band & Guard Estimated Fees for Band Members Band Member Fair Share: $ Band member fee (includes meals, show & sponsor shirts, Austin competition trip) Other Costs: $40.00 Marching shoes (required for new members and those needing a replacement) $6.00 Water jug (required for new members and those needing a replacement) $15.00 Logo shorts (required for new members and those needing a replacement) $10.00 Gloves, set of 3 (required for brass and woodwind members) $13.00 Percussion shirt (required for percussion members) $50.00 Jazz Band fee (required for jazz band members) $25.00 Vegetarian or gluten-free meal option $15.00 Tuxedo shirt for concert season (if needed due in spring semester) School-owned Instruments Usage Fee: $80.00 Payable directly to RPHS front office for students who use school-owned instruments due in September U.I.L. Region Band Contest: $15.00 Entry fee--due in September U.I.L. Solo and Ensemble Contest: $10.00 Entry fee per event due in December $45.00 Piano accompanist fee (if needed) due in January Band and Guard Spring Banquet (April or May): Approximately $15 varies from year to year

12 Ridge Point High School Band & Guard Estimated Fees for Guard Members Color Guard Fair Share: $ Color guard fee (includes meals, show & sponsor shirts, Austin competition trip) Other Costs (for new members and those needing replacements): $37.00 Performance shoes $17.00 Gloves $21.00 Jazz pants $63.00 Jacket $31.00 Body tights $15.00 Band logo shorts $12.00 Bag $6.00 Water jug $25.00 Vegetarian or gluten-free meal option Winter Guard Fee: $ Participation fee--due in January Band and Guard Spring Banquet (April or May): Approximately $15 varies from year to year