Vous êtes sur la page 1sur 4

Turn in this form to Mr.

Mayfield

1- Albright Choir Information Packet


Student Contact Information Form
*This information will be used to send out emails updating everyone about the upcoming events in the choir. Please leave as much
information as possible so that we can contact you with all the information available.

Student Name ________________________________________ Grade 7th 8th .


Please Print Circle One

Student ID#________________ Gender Female Male Student Birth Day _________________


Please Print Circle One Please Print

Primary Care Giver(s) Name/Relation: ______________________________________________________


(Jane Smith/Mother, John Doe/Grandfather, ect.)

Home Address_______________________________________________________________________________
Please Print

City____________________________ State________ Zip______________

Parent Email ____________________________________________________________


Please Print

Phone Numbers: Home ________________________________


Please print
.

Work ________________________________

Cell ________________________________

----------------------------------------------------------------------------------------------------------------------------- ---------------------------------

Order Your Student Choir T-Shirt

Adult- S M L XL XXL XXXL .


Circle One

Any other information that you think I need to know…


(Other family contacts, medical conditions, bragging, ect…)
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
Turn in this form to Mr. Mayfield

__________________________________________________________
__________________________

2- TRIP PERMISSION SLIP/MEDICAL RELEASE

DATE/EVENT: Various Choir Trips throughout the 2018-2019 School Year including (but not limited to):
(Games, Alief Choir Day, UIL Contests and Concerts, etc.)

I, ________________________________ (student name) pledge to abide by all district policies of the Alief
Independent School District student handbook. I understand that I am governed by the same rules on this trip as when
I am at school. Any failure to adhere to these policies will result in disciplinary action.

_________________________ ___________________________________ _________________ _______


Social Security Student Signature Month, Day, Year Grade
of Birth
We (I), the parent(s)/guardian of _______________________________ understand and agree that the trip is a school
sponsored activity and function. This release is intended to cover all injuries and illnesses of every name, type, kind or
nature, and personal property damage, if any, which may be sustained or suffered from any cause connected with or
arising out of, or from participation in the listed events. I understand I am responsible for transportation costs if my
child is required to return home for disciplinary measures. I understand I will be given a choice of mode of
transportation to be used.

EMERGENCY MEDICAL RELEASE FORM

NAME _________________________________________________________________________________________
PARENT/GUARDIAN ____________________________________________________________________________
ADDRESS _____________________________________________ WORK PHONE # _____________________
EMERGENCY CONTACT PERSON ________________________________________________________________
EMERGENCY PHONE # ______________________________ RELATIONSHIP TO STUDENT _______________
INSURANCE COMPANY _________________________________________________________________________
POLICY # ______________________________________________________________________________________
HOSPITAL PREFERENCE ________________________________________________________________________
DOCTOR’S NAME & NUMBER ___________________________________________________________________
BLOOD TYPE ____________________ KNOWN ALLERGIES ____________________________________
MEDICATION __________________________________________________________________________________
ANY ADDITIONAL MEDICAL INFORMATION _____________________________________________________
_______________________________________________________________________________________________
In case of emergency, I authorize emergency treatment to be administered if I cannot be contacted.

______________________________________________________
PARENT/GUARDIAN SIGNATURE

STUDENTS WILL BE TRANSPORTED TO THE ALIEF POLICE DEPARTMENT IF NOT PICKED UP WITHIN 45
MINUTES OF RETURN TO CAMPUS.
*********************************************************************************************************
For sponsor use:
Turn in this form to Mr. Mayfield

CONTACT ATTEMPT: TIME & DATE INITIALS


____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

3-Student/Parent Contract
Student Name ________________________________________
Please Print

Please Check In Acknowledgement


I have received access to the Albright Middle School Choir Department Handbook, Contract,
Treatment Agreements, and Calendar found online and I understand the responsibilities therein.

Photography Acknowledgement:
My student’s photo may be used on the Albright Middle School Choir web page, Twitter, and
 Instagram pages unless otherwise noted.

Transportation Acknowledgement:
My student is granted permission to travel with the Albright Middle School Choir Program to attend
 and participate in competitive, educational, and social events scheduled in the Choir Calendar,
unless otherwise noted. Please be aware that Events, Dates, and Times may be updated or added
to the calendar as the year progresses.

Equipment Acknowledgement:
Dear Parent, During the course of the year, your child may be issued and/or be in possession of
and/or use equipment that is owned and maintained by the Alief Independent School District. Alief
ISD provides for repairs necessitated by the normal day-to-day use of the equipment at no cost.
However, the student’s parent or guardian may be held responsible for repair or replacement costs
associated with theft, accidental loss, and/or damage due to neglect, carelessness, or abuse.
Please Check In Acknowledgement
I understand that the above student and I, as parent or guardian, are responsible for the school
 equipment exercising all reasonable care of it while under the student’s custody, care and control
and accept financial responsibility for repair and/or replacement of such equipment as outlined in
this document.

Device Usage BYOD Acknowledgement:


Albright Middle School has a Bring Your Own Device (BYOD) Policy. This is to bring attention to the
 school wide-rule that students have permission to bring cell phones, tablets, or other electronic
devices to school to use for educational purposes. Violation of policies results in devices being taken
up and students having to pay $15 to get their devices back from the front office.
Chaperone Volunteers:
Please Check All that apply ** No commitment

I could help Chaperone during the School Day


(Help Assign Uniforms/ Picture Day/ UIL/ Pop Show Dress Rehearsal)

I could help Chaperone on a weekday afternoon/evening


(Pizza party/ Fall Concert/ Men’s Night Out/ Christmas concert/ Spring Concert/ & Pop Show)

I could help Chaperone on the Weekends


(Region Workshop/National Anthem Performances/Region Auditions/Solo and Ensemble Competition)
Turn in this form to Mr. Mayfield

_______________________________________________ ______________
Students Signature Date

_______________________________________________ ______________
Parent Signature Date