2026-2027 Marching Band Member Form
Student Information
Student Name
*
First Name
Last Name
Student Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Student E-Mail Address
example@example.com
Student Cell
Please enter a valid phone number.
Format: (000) 000-0000.
Instrument/Section
*
Please Select
Drum Major
Flute
Clarinet
Bass Clarinet
Alto Sax
Tenor Sax
Bari Sax
Trumpet
Mellophone
Baritone
Tuba
Percussion
Color Guard
Dance Team
T-Shirt Size (Adult Sizes)
*
Please Select
X-Small
Small
Medium
Large
X-Large
2X-Large
3X-Large
4X-Large
Grade (26-27 School Year)
*
Please Select
7
8
9
10
11
12
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
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Month
Please select a day
1
2
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5
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7
8
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11
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14
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19
20
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22
23
24
25
26
27
28
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30
31
Day
Please select a year
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
Year
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2026-2027 Rock Hill Band
Field Trip & Medical Treatment Permission and Release
Sponsor Name: Rock Hill High School Band Staff and Chaperones
In consideration of permitting my child to accompany the Rock Hill High School Band on its trips to football games, festivals and other related band trips during the 2026-2027 school year, I hereby agree to indemnify and hold harmless the Rock Hill High School Band, Rock Hill School District #3, its teachers, employees, chaperones and trip sponsors against any claim for damages, compensation or otherwise on the part of said minor(s) or his (her) heirs, executors or administrators and to reimburse or make good any loss or damages or costs the Rock Hill High School Band, Rock Hill School District #3, its teachers, employees, chaperones or trip sponsors may have to pay if litigation arises on behalf of any claims made by said minor(s) or anyone on his (her) behalf as a result of injuries sustained by my child on said trips.The student participant listed above and the parent(s)/guardian(s) whose signature(s) appear below hereby consent to all medical and, or surgical procedures, including anesthesia and operations which may be deemed necessary and/or advisable by his/her attending physician and surgeons. The intention hereof, being to grant authority to administer and perform all procedures, which may now, or during the course of a patient's care, be deemed advisable or necessary. I/we also agree that patient, when admitted, will remain in the hospital until his/her physician recommends discharge. In witness of my/our consent and agreement to the matters stated above, I/we have subscribed my/our signatures below: EVERY EFFORT WILL BE MADETO CONTACT PARENTS OR GUARDIANS IN ADVANCE OF TREATMENT, BY TELEPHONE, IN CASE OF INJURY OR ILLNESS.
Contact Information
Parent/Guardian Name
*
First Name
Last Name
Cell Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Other Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Occupation
Parent/Guardian Name
First Name
Last Name
Cell Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Other Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Occupation
Email
example@example.com
Emergency Contacts (other than parent/guardian)
Please list at least one.
Name
*
First Name
Last Name
Relationship
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Name
First Name
Last Name
Relationship
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
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Medical Information
Responsible Party (insurance policy holder)
First Name
Last Name
Insurance Company Name
Policy Number
Specific medical/physical conditions
Medications student may be allergic to:
List any medications to be taken (over the counter or prescription) along with the dosage. Bottles are to be labeled with the correct name, dosage, and schedule.
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Member Commitment
Parent Signature
*
Student Signature
*
Date
*
/
Month
/
Day
Year
Date
Submit
Should be Empty: