Instrumental Music Registration

2022 Instrumental Music Registration

Step 1 of 6 - STUDENT INFORMATION

PARENT / GUARDIAN INFORMATION - PRIMARY CONTACT
Relationship to Student*
Primary Contact
- Mother
- Father
- Guardian
Name*
First Last
Address (if different from student)
Street Address City State Zip
Parent/Guardian Email*
Parent/Guardian Cell Phone*
Parent/Guardian Home Phone*
PARENT / GUARDIAN INFORMATION - SECONDARY CONTACT
Relationship to Student
Primary Contact
- Mother
- Father
- Guardian
Name
First Last
Address (if different from student)
Street Address City State Zip
Parent/Guardian Email
Parent/Guardian Cell Phone
Parent/Guardian Home Phone

Instrumental Music Permissions
Authorization to share email with Arapahoe Band Boosters*
Parent/Guardian email(s) provided in this form will be shared with the Arapahoe Boosters for sending student statements, sharing schedules and updates, information about concert dress, fundraisers, and volunteer opportunities.
Field Trips Permission*
Student has my permission to go on all field trips on various dates throughout the school year.
Electronic Communication Permission*
Student has my permission to receive emails and text messages from Arapahoe Band Boosters and staff regarding band activities.
Medical Information Permission*
Certain medical information (such as allergies, asthma, etc.) as well as emergency contact phone numbers will be shared with staff and chaperones.
Media Release Permission*
Arapahoe Band Boosters request your permission to photograph or video your child for use on program related websites, communications and social media.
Parent Permission for Student Passengers in Private or Commercial Vehicles*
Student has my permission to ride in a private or commercial vehicle to an activity during the period June 1, 2022 through May 31, 2023. This is a school-related activity and will be supervised by his/her teacher. I understand that it is my responsibility to verify that the owner of the vehicle in which my son/daughter will be traveling has adequate liability insurance coverage. I understand that the district does not provide insurance coverage for personal or commercial vehicles used for school activities. Each participant is responsible to be at the site of the activity at the announced time. I further hereby release and forever discharge Littleton Public Schools, its representatives, employees, officers, and directors from any and all liability arising out of or relating to the private or commercial vehicle while transporting my child to any school-sponsored activity.
- Yes, my student named above has my permission to ride in a private or commercial vehicle for the purpose of attending the events as indicated above.
- No, I do not wish to grant permission for my student named above to ride in a private or commercial vehicle for the purpose of attending the events as indicated above. I WILL PROVIDE TRANSPORTATION FOR MY STUDENT.
I UNDERSTAND THAT BY SELECTING NO, I AM RESPONSIBLE TO PROVIDE TRANSPORTATION TO/FROM ALL BAND ACTIVITIES.*
- I agree
Parent/Guardian Signature*

Medical Release
Parent/Guardian 1*
First Last
Relationship to student*
Home Phone*
Cell Phone*
Parent/Guardian 2
First Last
Relationship to student
Home Phone
Cell Phone
Alternate Contact*
First Last
Relationship to student*
Phone*
Insurance Company*
Policy Holder*
Policy Number*
MEDICATIONS
DOSAGE
ALLERGIES/ALLERGIC REACTIONS TO MEDICATION
FOOD ALLERGIES
MEAL PREFERENCE
Such as vegetarian, gluten free, etc.
MAJOR SURGERY IN PAST YEAR
ACUTE OR CHRONIC MEDICAL CONDITIONS
PHYSICAL CONDITIONS THAT LIMIT ACTIVITIES
CONSENT FORM / RESPONSIBILITY CLAUSE / MEDICAL PERMIT
I hereby agree that the above named student will participate in the Arapahoe High School Band Program. In case of emergency, I hereby give my consent for a qualified physician to perform any medical or surgical procedures s/he deems necessary to the welfare of this student while participating in the Arapahoe High School Band Program. It is understood that the Arapahoe High School and medical personnel will make every attempt to contact relatives listed above before taking any such actions. Further, this authorization permits said physician to hospitalize, secure appropriate consultation, order injections, anesthesia (local, general or both) or surgery for this applicant if such emergency conditions warrant. I, the undersigned, do hereby assume and agree to pay any indebtedness or physician’s or surgeon’s fees and hospital charges for such services.
Parent/Guardian Initials*
Parent/Guardian Signature*

Arapahoe High School

Parent Permission for Student
Passengers in Private Vehicles
Student name*
(student) has my permission to ride in a private vehicle to an activity during the current school year. This is a school-related activity and will be supervised by his/her teacher. I understand that it is my responsibility to verify that the owner of the vehicle in which my son/daughter will be traveling has adequate liability insurance coverage. (Minimum standards for liability coverage are $100,000/$300,000 for bodily injury, $50,000 property damage).

Each participant is responsible to be at the site of the activity at the announced time.

I further hereby release and forever discharge Littleton Public Schools, its representatives, employees, officers, and directors from any and all liability arising out of or relating to the private vehicle while transporting my child to the school-sponsored activity.

Please indicate your permission for your son/daughter to drive his/her private vehicle by filling out the required insurance carrier information and by signing and returning this form.

I give my permission for my son/daughter to drive his/her/my own vehicle to school-sponsored events during the school year. I understand that all liability for any accidents will be borne entirely by my student and/or myself.
Please indicate below if your son/daughter may or may not be transported in a private vehicle. Check all that apply.*
- Option 1: Student may ride in a personal vehicle driven by a staff member (teacher, office staff)
- Option 2: Student may ride in a personal vehicle driven by another student/parent.
- Option 3:Student may not ride in a personal vehicle.
Parent/Guardian Signature Option #1*
Parent/Guardian Signature Option #2*
Parent/Guardian Signature Option #3*
Date*
MM slash DD slash YYYY

2022 Instrumental Music Registration

Step 1 of 6 - STUDENT INFORMATION

PARENT / GUARDIAN INFORMATION - PRIMARY CONTACT

PARENT / GUARDIAN INFORMATION - SECONDARY CONTACT

Instrumental Music Permissions

Medical Release

Arapahoe High School

Parent Permission for Student
Passengers in Private Vehicles

Family Contribution

Title

2022 Instrumental Music Registration

Step 1 of 6 - STUDENT INFORMATION

PARENT / GUARDIAN INFORMATION - PRIMARY CONTACT

PARENT / GUARDIAN INFORMATION - SECONDARY CONTACT

Instrumental Music Permissions

Medical Release

Arapahoe High School Parent Permission for Student Passengers in Private Vehicles

Family Contribution

Title

Arapahoe High School

Parent Permission for Student
Passengers in Private Vehicles