Zone 3 Area All-State Information

Student Name: Carson Nicely Grade: 12

Instrument: Soprano
Ensemble: SH Chorus
Teacher Name: Cara McLaughlin
District & Building: Homer CSD / Homer Senior High School

Parent/Guardian Emergency Contact Information:

Students, Parents, Guardians: Please understand that a full commitment must be made to attend all rehearsals
and performances, and that the music must be prepared thoroughly, in advance of the first rehearsal. Students
must attend all parts of all rehearsals and performances. There are absolutely no exceptions to this policy for any
reason. Please double check all school and family obligations prior to signing this form. All students must stay for
the full duration of the concert and will be dismissed after the last ensemble performs. Failure to adhere to the
attendance policy will result in dismissal from the ensemble. Furthermore, by participating ina NYSSMA sanctioned
event, the performer's image or likeness may be used in NYSSMA's publicity efforts. | hereby acknowledge that,
if accepted, my performance may be photographed, reproduced and/or recorded on compact disc, dvd,
video file, livestream, and/or other similar devices and may be displayed and/or heard in
NYSSMA® publications and/or on the NYSSMA® website without remuneration.

Teachers and Administrators: Please do not sign this form unless you have fully reviewed the NYSSMA
Attendance Policy with your students and have confirmed that there are absolutely NO school related
performances or rehearsals or other conflicts to prevent full commitment. In the absence of a Music
Administrator/Lead Teacher/Liaison, the School Principal can sign to signify that the district/school is fully aware of
both the "No Exception" attendance policy PRIOR to any nomination or commitment form submissions.

COVID-19 PROTOCOLS:

@ None at this time.

e | hereby acknowledge that | fully understand the nature and extent of the risks presented by COVID-19
and other contagious diseases that exist due to my in-person attendance at the NYSSMA® Area All-State.
These risks include, but are not limited to, the inherent risk of being exposed to, spreading and/or
contracting COVID-19, a highly contagious virus, which can lead to serious and potentially life-threatening
illness and even death. | nevertheless hereby choose to accept the risk of being exposed to, contracting
and/or spreading COVID-19 and other contagious diseases, in exchange for being able to attend the
NYSSMA® Area All-State. With full knowledge of the risks involved, therefore, | hereby release, waive,
and discharge NYSSMA®/NAfME, its officers, directors, employees, contractors, and agents, from any
and all liability, loss, damage, claims, demands, actions, and causes of action whatsoever, including
reasonable attorneys’ fees, directly or indirectly arising out of or related to any loss, damage, injury, or
death, that may be sustained by me while
participating in this event or while in, on, or around the event premises that may lead to exposure or harm
due to COVID-19 or other contagious diseases. | agree that this waiver means | give up my right to bring
any claims including, but not limited to, claims of negligence.

Student Signature Date

Parent Signature A Date
Teacher Signature “4Y_y24, 4,£4 _ Date 7//%/27
Music Admininstrator Signature (GAY er Date Gl iY/>23

To be considered for nomination into the NYSSMA AAS Ensemble, this form must be returned to your music
teacher by: 2023-9-25. Please list any pertinent medical information or special needs that NYSSMA should
be aware of below. (allergies, medications, Epi-Pens, asthma, etc., continue on back if necessary)