Boswell Band Registration- Updated Step 1 of 9 11% BAND PARTICIPATION FORMLegal Name* First Last Gender*MaleFemaleDOB*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Age*School*Boswell High SchoolGrade (you will be in for the 2018-2019 school year)*Select Your Grade9101112Student ID*Height*Weight*Home Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Student Email Address (Must be a valid email address)* Student Cell PhoneT-Shirt Size*Select OneX-SmallSmallMediumLargeX-LargeXX-LargeXXX-LargePARENT/GUARDIAN #1- CONTACT INFORMATIONLegal Name* First Last Email (Must be a valid email address)* Relationship*Home Phone*Cell PhoneHome Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Employer Name* Employer Name Work PhonePARENT/GUARDIAN #2- CONTACT INFORMATIONLegal Name First Last Email (Must be a valid email address) Home PhoneCell PhoneHome Address Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Employer Name Employer Name Work PhoneEMERGENCY CONTACT INFORMATIONRelative/Friend not living in home to call in case of an emergency.Emergency Contact* First Last Emergency phone*Emergency Relation*Aunt, Uncle, Grandparent, etc...INSURANCE INFORMATIONStudent is covered by which parent's plan?*Parent/Guardian 1Parent/Guardian 2No InsuranceInsurance Company*Insurance phone*Insurance Policy Number*PHYSICIAN INFORMATIONPrimary Physician First Last Physician PhoneAre you currently being treated for a medical condition?*YesNoPlease list:*Is student currently taking any medications?*YesNoMedications*Does student have any food or other allergies we should be aware of?*YesNoPlease list:*Is student allergic to any medications?*YesNoPlease list:*Other information to assist with student emergency care:Attestation*I attest that the above information is accurate and true MEDICAL PROCEDURES1. The school district does not provide band insurance coverage. The EMS-ISD does not accept financial responsibility for injuries incurred while participating in the district's band program. 2. When applicable, the EMS-ISD Band Staff and/or nurse will summon emergency medical assistance when they feel that the situation warrants that level of care or when they are unable to contact a parent or guardian of an injured band student. The school district or employees will not be liable for the cost of this care or service. The band staff and/or nurse shall make a reasonable attempt to contact you prior to this level of intervention, as long as it does not interfere or slow down care being given to the injured student. The parent is responsible for any cost or damages as a result of any injury to your son/daughter while participating in school activities. 3. Doctor and Parent Notes: If your child goes to the doctor for any reason, he/she MUST bring a note from the doctor to the directors. The note must say whether they can or can not participate. If the student does not bring a note, the directors will reserve the right to deny participation to the student until the note is provided. Parent notes are not accepted as an excuse for not participating (unless the parent is a licensed doctor). Emergency Medical Questionaire Attestation*I KNOW OF NO MEDICAL CONDITION OR PROBLEM THAT SHOULD PREVENT MY CHILD AND/OR WARD FROM PARTICIPATING SAFELY IN ANY ATHLETIC PROGRAM OF THE SCHOOL DISTRICT IN WHICH I RESIDE. IF, IN THE JUDGEMENT OF REPRESENTATIVE OF THE SCHOOL, SCHOOL DISTRICT, THIS STUDENT SHOULD NEED IMMEDIATE CARE AND TREATMENT AS A RESULT OF ANY INJURY OR SICKNESS, I DO HEREBY REQUEST, AUTHORIZE AND CONSENT TO SUCH CARE AND TREATMENT AS MAY BE GIVEN SAID STUDENT BY ANY PHYSICIAN, MEDICAL CARE FACILITY, ATHLETIC TRAINER, NURSE, OR SCHOOL REPRESENTATIVE, AND DO HEREBY AGREE TO INDEMNIFY AND SAVE HARMLESS THE SCHOOL DISTRICT AND ANY SCHOOL REPRESENTATIVE FROM ANY CLAIM BY ANY PERSON WHOMEVER ON ACCOUNT OF SUCH CARE AND TREATMENT OF SAID STUDENT.Medical Procedures Attestation*I, as parent/guardian of student listed in this form, understand and agree to follow the guidelines in paragraphs one, two, three, and four. I hereby authorize a nurse or the Eagle Mountain-Saginaw Independent School District Licensed Athletic Trainers to administer to my minor child over the counter medication according to the directions contained on the medications original label.I, as parent/guardian of student listed in this form, understand and agree to follow the guidelines in paragraphs one, two, three, and four. I, however, DO NOT authorize a nurse or the Eagle Mountain-Saginaw Independent School District Licensed Athletic Trainers to administer to my minor child over the counter medication according to the directions contained on the medications original label. 2018-2019 MEMBER CONTRACT By signing this contract, I (student name above), acknowledge and accept the expectations put forth by the directors of the Boswell Bands. By accepting this position, I agree to do everything expected of me by the school, the organization, and the directors and adhere to the rues and guidelines laid out verbally, in the school student handbook and the band handbook. I commit to give my best and full effort in my attitude, academics, attendance, musical performance, and marching fundamentals. I will commit to better myself, my sections, and the band, and to continue to work towards success by taking whatever steps are necessary an needed throughout the season. I understand that I will be expected to participate in extra sectionals outside of school, participate in solo & ensemble contests, and in additional concerts, performances, and events. I understand that I am responsible for providing all of the materials and equipment presented in the handbook, which are essential to my success, and that failure to do so may result in the removal of the student from the percussion or band class. I take pride in being a member of the Boswell Band Program; in signing this contract, I demonstrate my understanding and acceptance of the expectations, and commit to be a positive member in continuing the history of excellence that is the Boswell Band of Gold.Acknowledgement*Both student and parent/guardian agree to the 2018-2019 Member Contract. EMS-ISD MANDATORY DRUG TESTING CONSENT, RELEASE, AND HOLD HARMLESS AGREEMENT I (parent/guardian listed above) am a parent/guardian of the student listed above, a student enrolled in the Eagle Mountain-Saginaw Independent School District (“EM-S ISD”) at the school listed above. My child intends to participate in one or more of the following extracurricular activities: school-sponsored athletics, band, cheerleading, dance, choir, and/or UIL academic activities ("Extracurricular Activities,” whether one or more). My child and I understand that participation in Extracurricular Activities is a privilege, not a right, and compliance with EM-S ISD‟s drug testing program is a condition to my child's participation in Extracurricular Activities. We have read and understand EM-S ISD's policy (available online) for testing student urine samples for prohibited substances including without limitation the following: alcohol, amphetamines, methamphetamines, barbiturates, benzodiazepines, cocaine metabolite, marijuana, methadone, opiates, phencyclidine, propoxyphene, hallucinogens, steroids, and all other illegal, addictive, or performance-enhancing drugs. We understand that all students in grades 7-12 who participate in Extracurricular Activities will be subject to random drug testing during the school year. Urine samples will be taken under conditions that are no more intrusive to students than the conditions experienced in a public restroom. We understand that EM-S ISD has contracted with FORWARD EDGE, INC/RON'S 24 HOUR MOBILE DRUG & ALCOHOL TESTING to collect urine samples for the purpose of testing for the presence of drugs and/or alcohol. We understand that if a test of the child's urine sample reveals the presence of a Prohibited Substance, EM-S ISD may take action against him/her up to and including termination of the child's participation in Extracurricular Activities. HAVING READ EM-S ISD’S DRUG TESTING POLICY AND THIS CONSENT FORM, WE REPRESENT THAT WE HAVE THE AUTHORITY TO CONSENT TO THE DRUG TESTING OF THE CHILD AND WE HEREBY AUTHORIZE THE COLLECTION OF URINE SAMPLES FROM THE CHILD FOR THE PURPOSE OF TESTING OF PROHIBITED SUBSTANCES. THIS AUTHORIZATION INCLUDES, BUT IS NOT LIMITED TO, AUTHORIZATION FOR FORWARD EDGE, INC/RON’S 24 HOUR MOBILE DRUG & ALCOHOL TESTING TO COLLECT URINE SAMPLES FROM THE CHILD FOR THE PURPOSE OF TESTING FOR THE PRESENCE OF DRUGS AND/OR ALCOHOL. We further authorize EM-S ISD, and/or FORWARD EDGE, INC/RON'S 24 HOUR MOBILE DRUG & ALCOHOL TESTING, and their officers, employees, and agents to communicate the child's drug test results both orally and in writing to each other, to us and the child's other parent/guardian, and/or to EM-S ISD administrators and personnel responsible for administering the testing program and extracurricular activities, and to communicate such test results at any EM-S ISD administrative or any other legal proceeding. I understand that the child's drug test results shall not be maintained in the child‟s educational file and shall be destroyed when the child graduates from high school. If the child graduates from a high school not part of EM-S ISD, then it shall be our responsibility to notify EM-S ISD of the child's graduation so that the drug test results can be destroyed. We also understand that no physician/patient relationship is established by the collection of urine samples by the designated, licensed medical facility or third party administrator. We understand that, except as set forth above, all test results shall be confidential and shall be disclosed only to the child, to myself, and to the child's other parent/guardian, and/or to designated district officials. Consent*WE HEREBY RELEASE AND HOLD HARMLESS EMS-ISD AND FORWARD EDGE, INC/RON’S 24 HOUR MOBILE DRUG & ALCOHOL TESTING, AND THEIR BOARD OF TRUSTEES, OFFICERS, EMPLOYEES, AGENTS, REPRESENTATIVES, AND MEDICAL STAFF MEMBERS FROM ANY AND ALL LIABILITY, CLAIMS, DAMAGES AND COSTS THAT MAY ARISE FROM OR BE RELATED DIRECTLY OR INDIRICTLY TO A DRUG TEST. THIS IS A LEGAL CONSENT AND RELEASE OF LIABILITY FORM. PLEASE READ THIS FORM CAREFULLY AND BE SURE YOUR QUESTIONS HAVE BEEN ANSWERED BEFORE SIGNING. THIS CONSENT, RELEASE, AND HOLD HARMLESS AGREEMENT SHALL BE EFFECTIVE AS LONG AS THE CHILD IS ENROLLED AT THE EM-S ISD SCHOOL CAMPUS DESIGNATED ABOVE, OR UNTIL WRITTEN NOTICE OF REVOCATION OF THIS CONSENT IS GIVEN TO THE PRINCIPAL OF SUCH SCHOOL. PARENT/STUDENT UIL MARCHING BAND ACKNOWLEDGMENT FORMNo 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 my 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 Rehearsal And/Or Performance - 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 fo the Eight-Hour Rule for Marching Bad can be found on the Music Page of the UIL Web Site at: www.uil.utexas.edu Consent*We have read and understand the Eight-Hour Rule for Marching Band as state above and agree to abide by these regulations. AUTHORIZATION FOR TRAVEL WITHOUT GUARDIANConsent*I (Parent/Guardian listed above) declare that I am the lawful Guardian of the student listed above. My child, has my consent to travel with the Boswell High School Band of 5805 W. Bailey Boswell Rd, Fort Worth, Texas, 76179 to travel to: all band related activities. In the event that my child requires emergency medical treatment and I cannot be reached, Boswell High School Band is authorized to consent to medical treatment in my stead.EXTRACURRICULAR TRAVEL EXPECTATIONSBy signing this contract, I, (Parent/Guardian #1), pledge to follow and adhere to the Boswell High School travel expectations. I agree to do everything expected of me by the school, the organization, and BHS faculty members. I will adhere to the rules and guidelines that have been given verbally, in the student handbook, and the code of conduct. I further agree to follow the below stated expectations for travel. Instructions and itineraries will be given to students prior to leaving Boswell High School. All members of the organization will travel to the destination together in school-approved transportation. All students will travel back to Boswell High School together. In case of an emergency or extenuating circumstance a parent or guardian may sign the student out with the BHS faculty member in charge. Students are not allowed to travel on their own or without a parent or guardian. Respect, Safety, Responsibility Travel Expectations: -Students are expected to follow all rules and regulations established and approved by Eagle Mountain-Saginaw school district in the Student Handbook and Code of Conduct. These expectations are in effect at all times. -All members of the travel party will be dressed to represent BHS in a positive way. Dress code for your organization will be set prior to departure with your BHS faculty member in charge. Appropriate and approved BHS clothing will be worn in all public places. (hotel, competition, bus, restaurants) -BHS Faculty Member will check roll prior to departure for each destination. All students will enter and exit through front passenger door, not emergency exit. They will have authority to designate expectations upon the bus. (Yelling/singing, assign seats, shoe polish, luggage, instruments, and appropriate conduct). -Students should always travel in groups of two at the venue. Nobody should walk off to the restroom or another part of the building without a travel friend. Nobody should ever leave the venue unless they are with the team. If an overnight stay is required: -Students will not be allowed to rent movies on pay per view or charge anything to their rooms. A BHS faculty member will have these features blocked upon arrival. -Students will stay with the group at the location at all times. Students are never allowed to be unattended. -A curfew shall be set by a sponsor on the trip. -Appropriate and approved clothing in all public places. (hotel lobby, bus, restaurants) -Room assignments are made prior to departure and will be attached to the itinerary. Switching rooms is not permitted. BHS Faculty will never share a room with a student. Coed groups will never share a room and will be separated without a common door connecting the two rooms. At no time, should any students of the opposite sex be in a room together. -At no time should students enter the hotel room of anybody who is not part of the BHS travel team or directly associated with the school. The only exception to this policy is if the parent is staying in the hotel. No other student may accompany that student into the room. -If interaction between students of the opposite sex is required or necessary, it must occur in a common area within the hotel and must occur prior to curfew. -No student should leave his or her assigned room for any reason, unless it is to confer directly with a coach (BHS Sponsor/Faculty Member). Phone contact should always be made prior to leaving the assigned room in an attempt to locate the coach. -Swimming/hot tub usage is not permitted unless a BHS Faculty Member is present. -No student may leave the grounds of the hotel. -All prescription medication must be placed in a clear plastic bag in the original packaging. It should have the student’s name on the bottle and designated dosage. The athletic trainer should be given the bag or the director if one our athletic trainers if not traveling. Exception will be made for insulin-dependent diabetics who must carry glucose testing supplies and insulin (including injection devices such as syringes or pen) with them at all times, as well as for individuals with severe food allergies who have explicit written permission to carry an epinephrine pen, provided by their primary care physician. -Students are responsible for any damage they cause to property.Consent: Travel Expectations*I (Parent/Guardian listed above) acknowledge and agree to the above travel expectations. PARENT/STUDENT UIL MARCHING BAND ACKNOWLEDGEMENT FORMConsent*I (Parent/Guardian listed above) declare that I have read and understand the UIL Eight Hour Rule. PRIVATE LESSON STUDENT ENROLLMENT FORM Private Lesson Program Fine Arts Department Eagle Mountain-Saginaw Independent School District It is the goal of the Eagle Mountain-Saginaw Independent School District Fine Arts Department to provide the very best learning experiences for each band/choir student. One of these learning experiences is the opportunity for a student to study privately with a professional instrumentalist/vocalist. This enrichment opportunity is available to all band/choir students in grades 6-12 and is optional. The Private Lesson Program serves a twofold purpose. It allows interested students to receive additional individual help in their musical training. Secondly, this individual attention generally improves the performance level of the individual student and also has a positive effect on the band/choir in which the student participates. General Information 1. Private teachers are selected and made available by the Eagle Mountain-Saginaw Independent School District Fine Arts Department. 2. Private lessons are available for all students in grades 6-12. 3. The private lessons are optional. The cost is $19.00 per 30-minute lesson. 4. Students electing to study privately are taught once per week during band/choir period, or before or after school. 5. If a student is absent from school or in school but cannot attend the lesson, prior notification of one day must be given in order for a make-up lesson to be scheduled. 6. If the student is in school and misses a lesson without prior notification to the teacher, the student will be financially accountable for that lesson in full. 7. Financial aid that pays for part of the lesson price is available to those students who qualify. Each school will select these students based on their application. If you are interested in financial aid, please consult with your child’s band/choir director. 8. Any parent interested in enrolling his/her child in private lessons is requested to complete the information on the back of this letter and return it to their child’s director. 9. Billing statements will be sent directly from the Private Teacher. Payments will be made directly to the Private Teacher. I am interested in private lessons for my child.*YesNoPrivate Teacher Last Year (if known) Name I am interested in financial aid for my child.*YesNoAre you interested in lessons*before schoolafter schoolSTUDENT SCHEDULEPeriod 1 ClassTeacher Name Name Period 2 ClassTeacher Name Name Period 3 ClassTeacher Name Name Period 4 ClassTeacher Name Name Period 5 ClassTeacher Name Name Period 6 ClassTeacher Name Name Period 7 ClassTeacher Name Name Period 8 ClassTeacher Name Name Please list before and after school activities SIGNATURESStudent Name* First Last DateStudent Signature*Parent/Guardian Name* First Last DateParent Signature*Pursuant to the Texas Uniform Electronic Transactions Act Section 322, an electronic signature has the same legal effect as a manual or handwritten signature. An electronic signature will not be denied legal effect or enforceability solely because it is electronic and any requirement for a signature is satisfied by an electronic signature. By submitting an electronic signature, the individual identified and providing the electronic signature herein verifies acknowledgement of the binding legal effect and enforceability of the electronic signature. You hereby swear that you are the parent or legal guardian of the above named student and that the information is accurate to the best of your knowledge.SUBMISSIONPlease click the submit button ONE time. After submitting the form you will receive an email with additional information. Please check your Spam box if you do not receive an email immediately.