Step 1 of 8 12% BAND PARTICIPATION FORMLegal Name* First Last Gender*MaleFemaleDOB*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Age*School*Saginaw High SchoolGrade (you will be in for the 2018-2019 school year)*Select Your Grade9101112Student ID*Height*Weight*Instrument Section*If you are a double reed (oboe/bassonn), please choose the instrument YOU play.Select Your InstrumentFluteOboeClarinetBass ClarinetAlto SaxophoneTenor SaxophoneBari SaxophoneBassoonTrumpetFrench HornTromboneEuphoniumTubaPercussionColor GuardHome 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 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 PhoneHas the student had or now has:Select all that apply Allergies Asthma Epilepsy Hypertension Diabetes Glasses Contacts Please explain those for which you have checked*List any medications taken regularly. MEDICAL POLICIES1. Financial Responsibility: 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. Emergency Care: When applicable, the EM-S ISD Athletic Staff and/or nurse will summon emergency medical assistance in the event that the situation warrants that level of care or the emergency contacts listed are unavailable. The athletic staff and/or nurse will always make a reasonable attempt to contact listed emergency contacts prior to this level of intervention, as long as it does not interfere with the 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. The school district or representative of the school district will not be liable for the cost of this care or service. 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 should outline in detail the level at which the student can or cannot participate. If a note is not presented, the directors will have discretion to determine level of participation for the student until note is provided. Parent notes are not accepted as an excuse for not participating (unless the parent is a licensed physician). 4. Head Injuries: Consistent with Texas State Law, “House Bill 2038”, ALL head injuries will be monitored by EM-S ISD Athletic Trainers according to the EM-S ISD Return to Play Protocol in conjunction with the UIL Concussion Management Protocol.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. STUDENT REGISTRATION FEES AND INFORMATIONThere are new student and returning student registration fees. Fees for 2018-2019 New Band - $600 Returning Band - $535 New Guard - $735 Returning Guard - $535 **Current prices listed is subject to change slightly once the budget information is released by the District.Acknowledgement*I AGREE TO PAY MY STUDENT'S REGISTRATION FEES FOR THE 2018-2019 SPIRIT OF SAGINAW BAND YEAR ON TIME BY THE AGREED DATES DISCLOSED BETWEEN THE BAND BOOSTER CLUB OFFICERS AND MYSELF. 2018 MEMBER CONTRACT By signing this contract, I (student name above), am accepting this position in the Spirit of Saginaw Band. By accepting this position, I agree to do everything expected of me by the school, the organization, and the directors and adhere to the rules 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 section, and the band, and to continue to work towards success by taking whatever steps are necessary and needed throughout the season. I also acknowledge that if I do not show I’ve put enough effort and commitment to this position, I will default my spot. I take pride in being a member of the Spirit of Saginaw Marching Band, and by signing this form, show my understanding and acceptance of the expectations, and commit to be a positive member in continuing the history of excellence that is the Spirit of Saginaw Band. Acknowledgement*Both student and parent/guardian agree to the 2018 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 MountainSaginaw 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 AUHORIZE 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 tests results shall be confidential and shall be disclosed only to the child, to me 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. 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 Spirit of Saginaw High School Band of 800 N Blue Mound Rd, Saginaw, Texas, 76131 to travel to: all band related activities. In the event that my child requires emergency medical treatment and I cannot be reached, Saginaw High School Band is authorized to consent to medical treatment in my stead. PARENT/STUDENT UIL MARCHING BAND ACKNOWLEDGEMENT FORMConsent*I (Parent/Guardian listed above) declare that I have read and understand the UIL Eight Hour Rule. Acknowledgement & ConsentAll must be checked We, parent and student, have read and agree to the Spirit of Saginaw Band Handbook. I, the parent, agree to pay my student's registration fees on time by the agreed dates disclosed between the band booster club officers, and myself. We, the student and parent, have read and understand the UIL Eight Hour Rule. I have read the EMSISD Drug Testing Policy and Consent Form, we represent that we have the authority to consent to the drug testing of the the child and we hereby authorize the collection of urine samples fro 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. I as the parent/guardian of the student, understand and agree to follow the guidelines in paragraphs 1-4 of the EMSISD Band Medical Policies Form We, the parent and student, have read and agree to the Extracurricular Travel Expectations. I, the parent of the student, hereby authorize the Eagle-Mountain- Saginaw ISD Licensed Athletic Trainers/nurse to administer to my minor child over the counter medication according to the directions contained on the medications original label. Typical medications administered (but not limied to): ibuprofen (Advil), acetaminophen (Tylenol), naproxen sodium (Aleve), diphenhydramine (Benadryl), Ioperamide (anti-diarrheal), and cough drops. 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.