MSMVA High School State Honors Choir

HIGH SCHOOL STUDENT CHECKLIST

  Parental Permission/Medical Consent Form

  ONE Lunch Order Form completed for BOTH Days

  ONE check made payable to your school or director. $85.00 per student

  Director Participation Form (completed by director – give this form to your director)

  Give forms to your director by December 9, 2015 so there is time to mail it by Dec. 11, 2015.

**All students will be tested for memorization in the first hour of rehearsal on Thursday Jan. 21

optional - If you would like to purchase an Honors Choir T-shirt and/or sweatshirt, please make out a separate check payable to LIGHTHOUSE SPORTSWEAR and SEND THAT CHECK & ORDER DIRECTLY TO:

LIGHTHOUSE SPORTSWEAR

P.O. Box 8

Grand Ledge, MI 48837

This must all be in the mail by December 11, 2015

MSVMA High School State Honor’s Choir

DIRECTOR PARTICIPATION FORM

Due: Must be mailed by December 11, 2015 (Directors: Only use one form per school for all 3 choirs)

·  School Name
·  Director
·  Address
·  School phone #
·  Home phone #
·  Email (checked daily)

**All students will be tested for memorization in the first hour of rehearsal on Thursday Jan. 21

Choir / Voice (1 or 2) / Student First Name / Student Last Name / Student fee $85 each
SATB
SATB
SATB
SATB
SATB
SATB
SATB
SSAA
SSAA
SSAA
SSAA
SSAA
SSAA
SSAA
TTBB
TTBB
TTBB
TTBB
TTBB
TTBB
TTBB

Total:

Please send school check and the following forms to:

Pam Pierson– Holland West Ottawa HS

3600 152nd Avenue

Holland, MI 49424

o  Parental Permission/Medical Consent Form

o  Student Lunch Order Form (one for each student) filled out for BOTH Days

o  School or director check for the above amount made payable to MSVMA

o  Director Participation Form

This must all be in the mail NO LATER THAN December 11, 2015

MSVMA High School State Honors Choir

PARENTAL PERMISSION/MEDICAL CONSENT FORM

Student Name ______

Choir þ(check one) c SATB c SSAA c TTBB

School ______

My son/daughter ______From______High School has my permission to participate in the MSVMA Honors Choir rehearsals and performance during the period from Thursday through Saturday, January 21-23, 2016. I recognize that MSVMA assumes NO liability for accident or injury outside the rehearsal setting. This includes any transportation to and from both rehearsal and performance sites, and student hotel arrangements. It is strongly recommended for the safety of the student that parents/guardians set all hotel reservations and chaperones firmly by this December 11th deadline.

During the above period, I hereby authorize and consent to emergency medical treatment in the event I/we cannot be reached at the following phone numbers:

______( )______

Guardian emergency phone number

·  Medical insurance carrier ______

·  Policy/Group number______

·  Please list any allergies, medical conditions, or special needs: ______

·  Students current prescriptions: ______

Name of HOTEL if known where your child will be staying (indicate home info if commuting)

·  Hotel name ______

·  Phone no. (______)______

·  Confirmation no. ______

CHAPERONES

1 – 3 student(s) must have a chaperone

4 – 7 students must have 2 chaperones

7 – 11 must have 3 chaperones

12 – 16 students must have 4 chaperones

Note: ALL FORMS MUST BE FILLED OUT COMPLETELY OR APPLICATION MAY BE DENIED. Return this printed form to choir director by December 9, 2015. (Director must mail all forms which must be postmarked by December 11, 2015)

FORMS NEEDED:

  School application form (filled out by school director)

  Permission form (this form)

  Lunch Order form

  (optional) Tshirt/sweatshirt order form with separate check made out to & form mailed directly to: LIGHTHOUSE SPORTSWEAR, P.O. Box 8, Grand Ledge, MI 48837

Please þ check your State Honors Choir:

¨SSAA ¨TTBB ¨SATB

MSVMA HS State Honors Choir 2016

Student lunch order (provided)

Student name:

School:

Friday, January 22

þChoose one (1)

o  Option 1

8” Cheese Pizza

Chips

Cookie

Whole Fruit

Bottled Water or Soft Drink

o  Option 2

Veggie Wrap w/Cheese

Chips

Cookie

Whole Fruit

Bottled Water or Soft Drink

o  Option 3

Turkey Wrap w/Cheese

Chips

Cookie

Whole Fruit

Bottled Water or Soft Drink

o  Option 4

Ham Wrap w/Cheese

Chips

Cookie

Whole Fruit

Bottled Water or Soft Drink

Saturday, January 23

þChoose one (1)

o  Option 1

8” Cheese Pizza

Chips

Cookie

Whole Fruit

Bottled Water or Soft Drink

o  Option 2

Veggie Wrap w/Cheese

Chips

Cookie

Whole Fruit

Bottled Water or Soft Drink

o  Option 3

Turkey Wrap w/Cheese

Chips

Cookie

Whole Fruit

Bottled Water of Soft Drink

o  Option 4

Ham Wrap w/Cheese

Chips

Cookie

Whole Fruit

Bottled Water or Soft Drink

All meals are peanut and tree nut free. You may choose from any of these 4 options. NO substitutions.

· Please send one form per student · Due December 11, 2015 · Please complete order for both days!

Send with all forms to:

Pam Pierson– Holland West Ottawa HS

3600 152nd Avenue

Holland, MI 49424