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Advanced Band Medical Form

This medical authorization form collects contact information for students participating in the Rochester Elementary Band. It requires emergency contact numbers, health information, and a parent/guardian signature. Incomplete forms will be returned to ensure all necessary details are provided in case the school needs to reach families for any reason regarding a student's participation in the band program.

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63 views1 page

Advanced Band Medical Form

This medical authorization form collects contact information for students participating in the Rochester Elementary Band. It requires emergency contact numbers, health information, and a parent/guardian signature. Incomplete forms will be returned to ensure all necessary details are provided in case the school needs to reach families for any reason regarding a student's participation in the band program.

Uploaded by

api-321347823
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Rochester Elementary Band

Medical Authorization
It is absolutely necessary for the band directors to have telephone numbers where the parent, or person
designated by the parent, can be reached for communication purposes. It also provides us important
information that will help us teach your child. Incomplete forms will be sent back home to be finished.
All items with a star (*) are required.

This form needs to be filled out completely.

*Child’s Name ____________________________________________ *Date of Birth ____/____/____

*Child’s School: ______________________________ *Classroom Teacher:


____________________

*Mailing Address __________________________________________________________________


STREET TOWN ZIP CODE

*Please indicate below who to call first by number:

*Father/Guardian ____________________________________________________________________________

*Home Phone.# ____ ____ ____ / ____ ____ ____ /____ ____ ____ ____

*Cell Phone# ____ ____ ____ / ____ ____ ____ / ____ ____ ____ ____

*Employed at ___________________________________________*Bus. Phone.#________________________

*Email Address _______________________________________@___________________________________

*Mother/Guardian ___________________________________________________________________________

*Home Phone. # ____ ____ ____ / ____ ____ ____ /____ ____ ____ ____

*Cell Phone # ____ ____ ____ / ____ ____ ____ / ____ ____ ____ ____

*Employed at ___________________________________________Bus. Phone.# _________________________

*Email Address _______________________________________@_____________________________________

*DESIGNATED PERSON TO CALL IF PARENTS CANNOT BE REACHED:

*Name _______________________________________________*Tel. # ______________________________________

*Please list any health conditions such as vision or hearing problems, allergies, chronic medical problems, injuries. etc .

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

*Date ______/______/______ *Signed _________________________________________________


Parent/Guardian (required)

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