Winter Guard Registration Step 1 of 6 - STUDENT INFORMATION 16% Welcome to the 2018-2019 Winter Guard Season! Please fill out ONE registration per student. The information below will not be shared outside of our program.Student Name* First Last Address* Street Address City State Zip Student 2018-2019 Grade*9101112Student Email (use your LPS email (@lpsk12.org)* Student Cell Phone*Student Home Phone* PARENT / GUARDIAN INFORMATION - PRIMARY CONTACTRelationship to Student*Primary ContactMotherFatherGuardianName* First Last Address (if different from student) Street Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific Zip Parent/Guardian Email* Parent/Guardian Cell Phone*Parent/Guardian Home Phone*PARENT / GUARDIAN INFORMATION - SECONDARY CONTACTRelationship to StudentPrimary ContactMotherFatherGuardianName First Last Address (if different from student) Street Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific Zip Parent/Guardian Email Parent/Guardian Cell PhoneParent/Guardian Home Phone PermissionsParent/Guardian email(s) and cell phone numbers provided in this form will be shared with the Arapahoe Boosters for sending student fee invoices, sharing schedules and updates, and volunteer opportunities.Authorization to share parent emails with Arapahoe Band Boosters*I AgreeI Do Not AgreeAuthorization to share parent cell phone number with Arapahoe Band Boosters*I AgreeI Do Not AgreeElectronic Communication Permission*Student has my permission to receive emails and text messages (via Remind) from Arapahoe Band Boosters and Arapahoe staff regarding winter guard activities.I AgreeI Do Not AgreeTravel Permission*Student has my permission to travel to all winter guard related competitions and activities.I AgreeI Do Not AgreeMedical Information Permission*Certain medical information (such as allergies, asthma, etc.) as well as emergency contact phone numbers will be shared with staff and chaperones.I AgreeI Do Not AgreeMedia Release Permission*Arapahoe Band Boosters request your permission to photograph or video your child for use on program related websites, communications and social media.I AgreeI Do Not AgreeParent 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, 2018 through May 31, 2019. 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.Parent Permission for Student Passengers in Private or Commercial Vehicles*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 ReleaseParent/Guardian 1* First Last Relationship to student*Home Phone*Cell Phone*Parent/Guardian 2 First Last Relationship to studentHome PhoneCell PhoneAlternate Contact* First Last Relationship to student*Phone*Insurance Company*Policy Holder*Policy Number*MEDICATIONSDOSAGEALLERGIES/ALLERGIC REACTIONS TO MEDICATIONFOOD ALLERGIESMEAL PREFERENCESuch as vegetarian, gluten free, etc.MAJOR SURGERY IN PAST YEARACUTE OR CHRONIC MEDICAL CONDITIONSPHYSICAL CONDITIONS THAT LIMIT ACTIVITIESCONSENT 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 VehiclesStudent 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* Winter Guard FeesWinter Guard is an auxiliary, optional program. This program is fully self funded. Fees are for instruction.Student Name* First Last Parent email for invoices* 2018 Winter Guard Fees* Price: $475.00 I understand and agree to pay all Winter Guard fees.* I Agree Parent/Guardian Signature*Date* Total $0.00
