1 - Summary - Rummel Chapelle Band

Transcription

ARCHBISHOP RUMMEL HIGH SCHOOL &
ARCHBISHOP CHAPELLE HIGH SCHOOL
BAND & CHAPELLETTES!
PACKET & FORM SUMMARY
2014 - 2015
This packet contains information for every member of the band – both
instrumentalists and Chapellettes – along with several forms and payments to be
returned by Notary Night (May 21, 2014). To help summarize and organize, please
refer to this checklist.
NOTARY NIGHT CHECK LIST
•
Fill out and bring the following forms:
!
!
!
!
!
!
!
!
•
Student Information Form – Including veteran members
Required Items Order Form – Instrumentalists Only
Medical Form
Handbook & Policy Agreement
Parental Permission Form: Band Events
Parental Permission Form: Disney
Catholic Mutual Form: Band Events
Catholic Mutual Form: Disney
Bring the following:
! Copy of student health insurance card
! Check for $155.00 for first band camp payment
! Check for required items – Instrumentalists Only
As a reminder of one of our new financial policies – please do not “combine” multiple payments
together into one check; the band has multiple accounts that we must balance separately and it
helps out the finance office if we submit payments on a per-account basis.
If you wish to pay for Band Camp all at once, you MAY combine the 2 band camp payments into a
single check for $310.00.
1901 Severn Avenue · Metairie, LA 70001 ·
!
· (504) 834-5592 · www.rummelraiders.com
Text
STUDENT INFORMATION FORM
2014 - 2015
Legibly and clearly fill out the following to the best of your ability.
STUDENT FIRST NAME
STUDENT LAST NAME
STUDENT GRADE
8
DATE OF BIRTH
MONTH
DATE
/
YEAR
9
10
11
PRIMARY INSTRUMENT / CHAPELLETTE
/
STREET ADDRESS
CITY
STATE
HOME PHONE NUMBER
STUDENT CELL PHONE
STUDENT EMAIL ADDRESS
(
(
)
YEARS OF BAND EXPERIENCE
MOTHER’S FIRST NAME
MOTHER’S LAST NAME
MOTHER’S WORK PHONE
MOTHER’S CELL PHONE
(
(
)
ZIP
)
GRAMMAR / MIDDLE SCHOOL
MOTHER’S EMAIL ADDRESS
)
FATHER’S FIRST NAME
FATHER’S LAST NAME
FATHER’S WORK PHONE
FATHER’S CELL PHONE
(
(
)
12
FATHER’S EMAIL ADDRESS
)
CURRENT PRIVATE INSTRUCTOR OR DANCE STUDIO
!
ANNUAL BAND DUES
2014 - 2015
The following fees are due on an annual basis for every instrumental band member.
These fees should be paid on their own check (not combined with other payments) and
by the dates specified below.
All instrumentalist checks (both boys and girls) should be made out to “Rummel Band.”
All Chapellette checks must be made out to “Archbishop Chapelle High School.”
BAND CAMP, FIRST PAYMENT - $155.00
•
•
All members including instrumentalists and Chapellettes
Due on May 21 at Notary Night
BAND CAMP, SECOND PAYMENT - $155.00
•
•
•
Instrumentalists: mailed into Rummel (1901 Severn Ave, Metairie, LA 70001)
Chapellettes: mailed into Chapelle (8800 Veterans Memorial Blvd, Metairie, LA
70003) or delivered to directors at a practice before the due date
Due on July 1
BOOSTER FEES - $75.00
•
•
All members including instrumentalists and Chapellettes
Due at first marching band practice after school starts
INSTRUMENT RENTAL FEE - $65.00 + $10.00 PER ADDITIONAL INSTRUMENT
•
•
Applies to any member using a school-owned instrument (tubas, percussion,
horns, etc.)
Due at first marching band practice after school starts
!
MEDICAL HISTORY & RELEASE FORM
STUDENT FIRST NAME
STUDENT LAST NAME
STUDENT SOCIAL SECURITY #
DATE OF LAST TETANUS SHOT
MONTH
YEAR
/
GENERAL PHYSICAL HISTORY
1.
Have you ever been hospitalized?
☐ YES ☐ NO
If yes, for what? __________________________________________________________________________
2.
_________________________________________________________________________________________
Have you ever had surgery?
☐ YES ☐ NO
If yes, for what? ___________________________________________________________________________
3.
4.
5.
6.
7.
_________________________________________________________________________________________
Have you ever passed out during or after exercise / physical exertion?
☐ YES ☐ NO
Have you ever been dizzy during or after exercise / physical exertion?
☐ YES ☐ NO
Have you ever had chest pain during or after physical exertion?
☐ YES ☐ NO
Have you ever been knocked out, fainted, or become unconscious?
☐ YES ☐ NO
Have you ever had a seizure?
☐ YES ☐ NO
If yes, how was it treated / addressed? _______________________________________________________
8.
9.
10.
11.
12.
13.
_________________________________________________________________________________________
Have you ever had heat or muscle cramps?
☐ YES ☐ NO
Have you ever been dizzy or passed out in the heat?
☐ YES ☐ NO
Have you been diagnosed with ADD or ADHD?
☐ YES ☐ NO
Have you had a psychiatric diagnosis such as depression, OCD, panic/anxiety?
☐ YES ☐ NO
Do you have an emotional health concern that will impact your participation?
☐ YES ☐ NO
During the past year, have you seen a professional about mental concerns?
☐ YES ☐ NO
ALLERGIES
☐ I have no known allergies.
☐ I have an allergy to this food: ___________________________ this causes anaphylaxis? ☐ YES ☐ NO
☐ I have an allergy to this medication: _____________________ this causes anaphylaxis? ☐ YES ☐ NO
☐ I have an allergy to these substances: _____________________ this causes anaphylaxis? ☐ YES ☐ NO
CHRONIC CONCERNS
☐ I have no chronic health concerns
☐ I have the following chronic health concern(s): ________________________________________________
_____________________________________________________________________________________________
Please disclose any medications being currently taken (e.g., Asthma, Diabetes, Seizures, Antibiotics,
Cough Syrup, etc.) or any other health concerns we may need to know about.
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
NAME OF YOUR PHYSICIAN
OFFICE PHONE
(
NAME OF YOUR DENTIST / ORTHODONTIST
OFFICE PHONE
(
EMERGENCY CONTACT 1 NAME
)
PHONE
(
EMERGENCY CONTACT 2 NAME
)
RELATIONSHIP
)
PHONE
(
RELATIONSHIP
)
Before me, Notary Public, came _______________________________,
PRINT PARENT / GUARDIAN NAME
who under oath said: I am the parent / guardian of _______________________________.
PRINT STUDENT NAME
Regarding my son/daughter, named above, I hereby give my consent and release for medical treatment
in the event of an emergency and understand that in non-medical emergency situations, reasonable
judgment may be used by any attending director or authorized chaperone in the dispensing of over the
counter remedies for minor medical conditions. I acknowledge that in giving my child any such
medications, there is a known risk from the same. I further allow my son / daughter to receive over-thecounter medications from a third party such as, but not limited to: chaperones (with director consent),
first-aid station attendants, and EMS personnel.
!
___________________________________
___________________________________
SIGNATURE OF PARENT / GUARDIAN
!
___________________________________
___________________________________
PRINT NAME OF WITNESS
SIGNATURE OF WITNESS
!
!
__________________
DATE ( MM/DD/YYYY )
!
2014 – 2015 REQUIRED ITEMS ORDER FORM
Please return this list with a check for the correct payment to “Rummel Band” and “2014-15
Required Items” on the memo. Items below must be replaced if they are destroyed, lost, or
otherwise rendered unusable. Mark “0” in item count below if you do not need to re-purchase an
item for this year.
______________________________
M / F
____________
_____________
Student Full Name
Shoe Size
T-Shirt / Polo Size
# Ordering
(From Office)
Cost From
Band Office
I will obtain this
item on my own
Total
ALL INSTRUMENTALISTS
“Foundations of Music” Book (for your instrument)
Drillmasters (Marching Shoes)
Band Polo
Red Band Practice Shirt
White Band Undershirt
Baseball Hat
Bows (Girls Only)
Red Gym Shorts (See ARHS bookstore)
Brown/Oxblood Belt
Marching Gloves
$7
$28
$25
$13
$13
$10
$3
N/A
N/A
N/A
N/A
N/A
N/A
N/A
✓
✓
$5
N/A
N/A
BRASS
Flip Folder
Lyre
BERP “Buzz Extension & Resistance Piece”
Stand-alone tuner (NOT an app)
$5
$6
$15
$20
WOODWINDS
Flip Folder
Lyre
Stand-alone tuner (NOT an app)
$5
$6
$20
PERCUSSION
Paul Rennick II’s Marching Sticks (FS-PR2)
Yarn Mallets
RealFeel Practice Pad
Vic Firth Standard Stick Bag
Stand-alone metronome (NOT an app)
$10
$35
$30
$15
$20
I have attached a check made out to “Rummel Band” for the amount of !
!
N/A
N/A
BAND & CHAPELLETTES
HANDBOOK & POLICY AGREEMENT
I / We have read and understand the information regarding the classroom objectives, grading
policies, requirements outlined in the Handbook, and behavioral expectations for enrollment
in this class. I / We agree to abide by all rules, regulations and expectations found in the
Handbook concerning this class and those in place outlined in the Rummel High School and
Archbishop Chapelle High School Student Handbook.
We further understand that these rules, regulations and guidelines apply to all functions
within the Advanced Band Class, including but not limited to football games, concerts and any
and all trips.
The authority granted herein shall include the authority to send my son / daughter home from
a trip if my son or daughter should reject the authority of the approved school representative /
chaperone or if my son / daughter should violate the regulations of the student handbooks of
Rummel or Chapelle High Schools. This authority granted shall also include the lowering of a
conduct or academic grade in the event it is deemed necessary by the DIRECTOR.
The authority herby granted shall include, but shall not be limited to, granting permission for
any medical and / or surgical treatment recommended by a duly licensed physician. In
addition to the treatment of minor needs administered to by the approved nurses traveling
with us (i.e. Tylenol, cough drops) as outlined and followed by the provided Medical History
and Release Form.
I / We further understand that all fees and payments must be made to the program, even if my
child removes himself/herself from the program for any items purchased for or paid for on
behalf of my child.
___________________________________
___________________________________
PRINT STUDENT’S NAME
___________________________________
___________________________________
SIGNATURE OF STUDENT
BAND & CHAPELLETTES
PARENTAL PERMISSION FORM: 2014 – 2015 BAND EVENTS
I, the undersigned, herby grant full authority over my son/daughter, ______________________,
to The Rummel / Chapelle Band Directors and designated Chaperones (acting on behalf of the
Band Directors) while with the Rummel Raider Band for practices, performances and trips as
designated on the monthly band calendars and website.
The authority granted herein shall include the authority to send my son/daughter home from a
trip if my son/daughter should reject the authority of the approved school
representative/chaperone or if my son/daughter should violate the regulations of the student
handbooks of Rummel or Chapelle High Schools. This authority granted shall also include the
lowering of a conduct or academic grade in the event it is deemed necessary by the DIRECTOR.
any medical and/or surgical treatment recommended by a duly licensed physician. In addition
to the treatment of minor needs administered to by the approved nurses traveling with us (i.e.
Tylenol, cough drops) as outlined and followed by the provided Medical History and Release
Form.
In addition, I hereby agree to hold the directors, chaperones/nurses and Archbishop
Rummel/Chapelle High Schools harmless for any occurrence resulting from the reasonable
exercise of this authority.
___________________________________
___________________________________
___________________________________
___________________________________
BAND & CHAPELLETTES
PARENTAL PERMISSION FORM: DISNEY
I, the undersigned, herby grant full authority over my son/daughter, ______________________,
to The Rummel / Chapelle Band Directors and designated Chaperones (acting on behalf of the
Band Directors) while with the Rummel Raider Band for all events relating to the 2015 trip to
Orlando, Florida.
These events include rehearsals, performances, bus trips, park visits, and any other relevant
even described on the band website or calendar.
The authority granted herein shall include the authority to send my son/daughter home from a
trip if my son/daughter should reject the authority of the approved school
representative/chaperone or if my son/daughter should violate the regulations of the student
handbooks of Rummel or Chapelle High Schools. This authority granted shall also include the
lowering of a conduct or academic grade in the event it is deemed necessary by the DIRECTOR.
any medical and/or surgical treatment recommended by a duly licensed physician. In addition
to the treatment of minor needs administered to by the approved nurses traveling with us (i.e.
Tylenol, cough drops) as outlined and followed by the provided Medical History and Release
Form.
In addition, I hereby agree to hold the directors, chaperones/nurses and Archbishop
Rummel/Chapelle High Schools harmless for any occurrence resulting from the reasonable
exercise of this authority.
___________________________________
___________________________________
___________________________________
___________________________________

1 - Summary - Rummel Chapelle Band

Transcription

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