2024-2025 Band Registration Form

2024-2025 Band Registration Form

Purple Regiment members and their families should submit an entry on this registration form for each student planning to participate in the 2024 Purple Regiment Marching Band at Northwestern High School.
Student Contact Information

Please submit the following information to change or to confirm the information we have on file.
Student Name*

First NameMiddle NameLast Name
Student Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Student E-mail Address
If the student does not have an e-mail address, please leave blank. Parent/Guardian e-mail addresses are added later in this form.
Student Mobile Phone
Please enter a valid phone number. If the student does not have a mobile phone number, please leave blank. Parent/Guaridan mobile phones are added later in this form.
Student Grade Level*
Select the anticipated grade level for the 2024-2025 academic year.
Student Gender*

MaleFemaleOther / Decline to State
Student Height*
Please provide current student height in feet and inches.
Student T-Shirt Size*
Student Date of Birth*

MonthDayYear
Date
Student Role in Marching Band*
Please select the section/instrument. If unsure, select "Unknown" in the dropdown menu.

Parent Guardian / Emergency Contact Information

The NHS Band requires we have AT LEAST ONE parent/guardian listed in our database for participating students. Up to four parent/guardian contacts may be submitted with this form. Use the plus sign (+) at the bottom of the form to add additional contacts.
Parent/Guardian Information*

Medical Permission & Information

Our volunteers are unable to give any medication to a student, even for a minor headache, without your consent on this form. If your student has prescription medications (i.e. rescue inhaler, epinephrine pen, etc.), please make sure your child has access to these devices always while participating in band activities. Our medical volunteers do not stock these medications in our supply kits. THESE FIELDS ARE ONLY TO BE COMPLETED BY A PARENT OR GUARDIAN.
Medication List
Please provide information on any medications taken on a regular basis by the student
OTC Medication Consent

BenadrylTylenolAdvilAntacidPepto Bismol
Medical Insurance Company Name
Providing medical insurance coverage information is optional, but encouraged in case of an emergency.
Policy Number / Member ID
Policy Holder Name

First NameLast Name
Insurance Company Phone
Please enter a valid phone number.
Parent/Guardian Signature - Medication Form*

Clear
Physical Form

A completed physical form is required to participate in marching band. If you have a digital copy of your completed physical form, you may upload it here. Physical forms must include the Preparticipation Physical Evaluation Physical Form and History Form, as specified by the American Academy of Pediatrics. Alternatively, you may e-mail your completed physical form or provide a hard copy to the band office.
Cancelof
Click Here to download a copy of the physical form.

Declaration of Intent

New and returning band students and a parent or guardian must fill out this section.
To the Student:

I, {studentName}, declare my intent to become a member of the Northwestern High School Marching Band, and I hereby authorize the band staff to reserve a position for me in the 2024 Northwestern High School Purple Regiment.
Student Signature - Intent

Clear
To the Parent/Guardian:

I authorize the band staff to reserve a position for my child, {studentName}, in the Northwestern High School Marching Band. With this authorization, I understand that if, for some reason, my child decides not to participate in the Northwestern High School Marching Band after declaring intent or is removed from the program for failure to meet obligations in full, the Northwestern Band will not be held responsible for refunding any fee money. I have also read the summer and fall schedules and understand the time requirements for participating in the Northwestern Purple Regiment.
Parent/Guardian Signature - Intent

Clear

Review and Submission

Please review your registration form and click submit to finalize submission.
Confirmation: Parent/Guardian E-mail Address*
Please enter the e-mail address of the form completer (parent/guardian) where a confirmation message may be sent.
Should be Empty:

Student Contact Information