Professional Documents
Culture Documents
Choir Student Paperwork With Medical Form
Choir Student Paperwork With Medical Form
Choir Student Paperwork With Medical Form
Mayfield
Home Address_______________________________________________________________________________
Please Print
Work ________________________________
Cell ________________________________
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__________________________________________________________
__________________________
DATE/EVENT: Various Choir Trips throughout the 2019-2020 School Year including (but not limited to):
(Games, Alief Choir Day, UIL Contests and Concerts, etc.)
I, ________________________________ (student name) pledge to abide by all district policies of the Alief
Independent School District student handbook. I understand that I am governed by the same rules on this trip as when
I am at school. Any failure to adhere to these policies will result in disciplinary action.
NAME _________________________________________________________________________________________
PARENT/GUARDIAN ____________________________________________________________________________
ADDRESS _____________________________________________ WORK PHONE # _____________________
EMERGENCY CONTACT PERSON ________________________________________________________________
EMERGENCY PHONE # ______________________________ RELATIONSHIP TO STUDENT _______________
INSURANCE COMPANY _________________________________________________________________________
POLICY # ______________________________________________________________________________________
HOSPITAL PREFERENCE ________________________________________________________________________
DOCTOR’S NAME & NUMBER ___________________________________________________________________
BLOOD TYPE ____________________ KNOWN ALLERGIES ____________________________________
MEDICATION __________________________________________________________________________________
ANY ADDITIONAL MEDICAL INFORMATION _____________________________________________________
_______________________________________________________________________________________________
In case of emergency, I authorize emergency treatment to be administered if I cannot be contacted.
______________________________________________________
PARENT/GUARDIAN SIGNATURE
STUDENTS WILL BE TRANSPORTED TO THE ALIEF POLICE DEPARTMENT IF NOT PICKED UP WITHIN 45
MINUTES OF RETURN TO CAMPUS.
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For sponsor use:
Turn in this form to Mr. Mayfield
3-Student/Parent Contract
Student Name ________________________________________
Please Print
Photography Acknowledgement:
My student’s photo may be used on the Albright Middle School Choir web page, Twitter, and
Instagram pages unless otherwise noted.
Transportation Acknowledgement:
My student is granted permission to travel with the Albright Middle School Choir Program to attend
and participate in competitive, educational, and social events scheduled in the Choir Calendar,
unless otherwise noted. Please be aware that Events, Dates, and Times may be updated or added
to the calendar as the year progresses.
Equipment Acknowledgement:
Dear Parent, During the course of the year, your child may be issued and/or be in possession of
and/or use equipment that is owned and maintained by the Alief Independent School District. Alief
ISD provides for repairs necessitated by the normal day-to-day use of the equipment at no cost.
However, the student’s parent or guardian may be held responsible for repair or replacement costs
associated with theft, accidental loss, and/or damage due to neglect, carelessness, or abuse.
Please Check In Acknowledgement
I understand that the above student and I, as parent or guardian, are responsible for the school
equipment exercising all reasonable care of it while under the student’s custody, care and control
and accept financial responsibility for repair and/or replacement of such equipment as outlined in
this document.
_______________________________________________ ______________
Students Signature Date
_______________________________________________ ______________
Parent Signature Date