2020-2021 SCMS Activity Permission Form
2020-2021 SCMS Instrumental Music Activity Permission Form
_________________________________________________________
Student's Name ( Please PRINT) PLEASE SIGN AND RETURN
Dear Parent/Guardian:
During the 2020-2021 school year, your child may be involved in a field trip activity for their ensemble or class. Your signature below indicates your consent for your child to participate. It, also, indicates that if any injury occurs the school will make reasonable efforts to contact you. In the meantime, you give permission, in the event of an injury, that your student may receive emergency medical aid, anesthesia and/or an operation if, in the opinion of the attending physician such treatment is medically necessary.
**My child has a medical condition requiring medical accommodations: O Yes O No
The following health concerns should be noted and adequate precautions taken (list allergies, medications, special diets, diabetes, heart disease, hemophilia,etc.)___________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
___________________________________________________ ___________________________________________________
Parent/ Guardian Printed Name Parent/ Guardian Signature
Date
Home Phone____________________________________________________
Work Phone_____________________________________________________
Cell Phone______________________________________________________
Please list any address changes OR other information we need to know on the back of this form:
_________________________________________________________
Student's Name ( Please PRINT) PLEASE SIGN AND RETURN
Dear Parent/Guardian:
During the 2020-2021 school year, your child may be involved in a field trip activity for their ensemble or class. Your signature below indicates your consent for your child to participate. It, also, indicates that if any injury occurs the school will make reasonable efforts to contact you. In the meantime, you give permission, in the event of an injury, that your student may receive emergency medical aid, anesthesia and/or an operation if, in the opinion of the attending physician such treatment is medically necessary.
**My child has a medical condition requiring medical accommodations: O Yes O No
The following health concerns should be noted and adequate precautions taken (list allergies, medications, special diets, diabetes, heart disease, hemophilia,etc.)___________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
___________________________________________________ ___________________________________________________
Parent/ Guardian Printed Name Parent/ Guardian Signature
Date
Home Phone____________________________________________________
Work Phone_____________________________________________________
Cell Phone______________________________________________________
Please list any address changes OR other information we need to know on the back of this form: