ARAB HIGH SCHOOL BAND

Activities Permission Slip

Student Name: _______________________________________________

Address: ____________________________________________________

Home Telephone: ____________________ Cell: ___________________

Date of Birth: ______________________ Grade: __________________

Name of Parent: ______________________________________________

Parent’s No: __________________ E-Mail: _______________________

Alternate Emergency Contact: __________________________________

Relation to Student: _________________ Phone No: _______________

Special Instructions: (Special Diets, Medications, Allergies, etc.)

_____________________________________________________________

Name of Insurance Company: __________________________________

ID No: _________________________ Group No: __________________

(copy of insurance card, front and back, required)

This is to certify that my child, ____________________________ has permission to participate in the Arab High School Band, and travel with them to specific band functions. I understand that he/she must follow the school and band rules in order to represent the Arab High School Band in a positive way.

In the event of an emergency, I give the staff and/or chaperones permission to give or seek any medical care as determined necessary.

______________________________________________ __________

Signature of Parent or Guardian Date

This form is available on our new band web site: www.arabband.org