TOMBALL INDEPENDENT SCHOOL DISTRICT

CO-CURRICULAR/EXTRACURRICULAR TRIPS

School year: 2016-2017

Dear Parent/Guardian:

Your child has the opportunity to participate in all band activities and events. To be able to do this you must complete the form below. It must be completed, signed and turned in by August 26, 2016. Your child will not be allowed to travel with the band until this form is on file in the band office.

Student Name (PRINT) ______Student ID:______

Date of Birth ______Male Female (Circle one) Grade______

Campus (Circle one) TIS TJHS Home Phone: ______

Address:______Zip: ______

Email address: (for newsletters and parental contact)______

Second

Father/Stepfather: ______Work #______Number______

Second

Mother/Stepmother: ______Work #______Number______

Alternate Emergency Contact: ______Phone #______Relation______

Medical Information about student:

Insurance Provider: ______Policy # ______

Existing medical condition/s: ______

Date of most recent

______Tetanus/Td Booster: ______

Allergies: ______

Medication/s taken routinely: ______

Special considerations: ______

______

My child (Print name) ______has my permission to participate in all band activities

Transportation provided by: TISD Transportation

Please be prompt in picking up your returning student.

Name of Sponsor: David N. Morgan, Cathy Breeden, Steve Fry, Kyle Winn, Rob Sullens,

I, the undersigned, do hereby authorize officials of the Tomball I.S.D. to contact persons named on this sheet in the event of illness, injury and/or inappropriate behavior of my child. If I or persons named on this sheet cannot be reached, T.I.S.D. school officials are hereby authorized to take whatever action is deemed necessary in their judgment, for the health and safety of said child. I realize that this form does not abrogate or modify my rights as a parent/guardian of a minor. I have voluntarily signed this form to facilitate and expedite the treatment of my child. I will not hold the Tomball I.S.D. or the school official(s) financially responsible for the emergency care and/or transportation of said child.

______

DATE Signature of Parent/Guardian