Marching Band Package 2018 Season - …€¦ · 2 MARCHING BAND MEMBERSHIP CONTRACT 2018 SEASON...

Marching Band Package 2018 Season

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MARCHINGBANDMEMBERSHIPCONTRACT2018SEASON

Parents/Students:PleasereadALLofthefollowinginformationandreturnallinformationthatrequiresasignatureandanyrequiredmoniesbyJune2,2018–thisincludestheCCSDFormsincludedinthispacket.STUDENTNAME:______________________________________________________________________________________________

CCSDSTUDENTID#:_____________________________________GRADELEVEL2018-2019_____________________

MARCHINGINSTRUMENT:__________________________________________________________________________________

PHYSICALADDRESS:StreetAddress______________________________________________________________________

City/Zip_________________________________________Subdivison___________________________________________

STUDENTEMAIL:_____________________________________________________________________________________________

STUDENTCELL#_______________________________________________________________________________________________

PARENT(S)EMAIL:____________________________________________________________________________________________

PARENT(S)CELL#:___________________________________________________________________________________________

STUDENTT-SHIRTSIZE:_________________SNEAKERSIZE(formarchingshoes):_____________________

IhavereadandunderstandallpoliciesandproceduressetforthbyHBBAandtheMarchingBandMembershipcontract.IunderstandIamenteringintoafinancialagreementwithHillgroveBandBoostersAssociation,a501(c)3nonprofitgroup.Iagreetopayfeesand/orfundraisetothebestofmyability.Iacknowledgepaymentinfullofbandfeesensures“goodstanding”status,whichenablesstudenttoparticipateinoptionalbandactivitiesandtripsduringthe2018-2019schoolyear.StudentSignature:______________________________________________ Date:_________________________ParentSignature:_______________________________________________ Date:_________________________

MARCHINGBANDDEPOSIT$200PAID________OR$900DISCOUNTRATE/PAIDINFULL__________

*Summerbandcampmealsofferedwithonlineorderthisyear.Link/detailssenttogroupinJune.

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MARCHINGBANDFEESCHEDULEStudentActivityFees:

$200non-refundabledepositwithcontractbyJUNE2nd

$200duebyJUNE30th$200duebyJULY31st

$200duebyAUGUST30th

$200duebySEPTEMBER30thTOTAL $1,000total

AdditionalExpensesthatMAYoccur: MTXMarchingShoesorColorguardShoes(ifnewpairisneededthisyear) Dri-Fitshirtandshortsforunderuniform–allblackonly AdditionalColorguardItems(makeup/hairsupplies/unitard)

FridayFootballGameMealPlanand/orcostofothermealsduringtheseason

***AnyfamilypayinginfullbyJune30th(harddeadline)willreceivea$100discount.***(Thusmakingtheactivityfee$900insteadof$1,000.)

1.Bringcashorcheck(preferablycheck)tothebandhallpayabletoHillgroveBandsBoosterAssociationandplaceitintheblacklockboxinthebandroomdesignatedforthispurpose.Yourcancelledcheckwill

beyourreceipt.PleasebeawarethatCobbCountyPolicyprohibitstheBandDirectorsfromreceiving

yourpayment.Ifpayingincash,youmustreceiveawrittenreceiptbeforefundswillbeaccepted.

2.CreditCardPaymentviaPayPalonthewebsite:www.hillgrovebands.com.

3.ChecksonlymaybemailedtoHillgroveBandstoourP.O.Box(postmarkedbytheJune30thdeadline)

(*NOTE:Thereisa$35feeassessedforanyreturnedcheck.)

…………………………………………………………………………………………………………………………………………………………….

MARCHINGBANDFEESCOVERSMANYOFTHEFOLLOWINGEXPENSES:

• Instructionalstaff *Contestregistrationfees• Uniformcosts *Props(materialandbuild-out)• Equipmentcosts *Traveltocompetitions• Colorguardflagsandcostumes *Administrativecosts• Showdesign(musicandvisual) *Additionalsuppliesnecessaryforthegroup

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INCLUDEDWITHFEES-**NEW!!

• Newwaterjug(newonesforeveryone–colorchange)

• 2pairsofgloveso (1blackforgamesand1whiteforcompetitions/additionalglovesare$4/set)

• 1pairoflongblacksocks(forthosewearingmarchingbanduniform)

• 1pairofglovesforcolorguard

• 1bandmagnetperfamilywitheachsigned/submittedcontracto Pleaseconsiderpurchasingmoreforadditionalcarsfor$8

• Studentshowshirt

**FridayandBandCampMealdetailsarecoveredonpage9inthispackage…………………………………………………………………………………………………………………………………………………………

REQUIREDITEMSFORWINDSANDPERCUSSION

Marchingbandisanextra-curricularactivitythatrequiresafewitemsthatarenecessarytoouractivity.Theitemsbelowarerequiredforallmarchingbandstudents.Someitemsbelowareoptional(as

indicated),andareavailablethankstoourbandboosterparentsandtheircommitmenttosupportour

students.FORWOODWINDS,BRASS,PERCUSSION:Item Cost DeadlineforPayment

MTX’sMarchingShoes $40 July30th

*SOLIDBLACKathleticshorts $10-25 availableatretailstores

*SOLIDBLACKathleticshirt $10-25 availableatretailstores

PercussionOnly:Sticks/Mallets TBD asneeded

*StudentsneedtopurchasebeforeAugust17thfootballgametowearunderuniform.FORCOLORGUARD:Item Cost DeadlineforPayment

Danceshoes(ifneeded) @$30 July20thfororder

Uni-tard(uniformundergarment/ifneeded) @$18 studentpurchasedWarm-upjacketandpants(ifneeded) @$75 September7thfororder

Rifle(forthosewishingtobeonrifleline) @$55 June2ndfororder

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POLICY–AGREEMENT&ATTENDANCEEachmemberoftheensemblemustreadandagreetothetermsasfollowsinordertoparticipate.In

return,theHillgroveMarchingBandanditsstaffwillprovideallnecessaryinstruction,materials,travel,

andexperiencesinordertoinsureasafe,productive,andrewardingexperience.

***PLEASERETURNALLTHEATTACHEDFORMSWITHYOUR$200DEPOSITBYJUNE2,2018.***

THE$200DEPOSITMUSTBERECEIVEDTOENSUREASPOTFORTHE2018MARCHINGSEASON.ATTENDANCEPOLICY:

1. Afullrehearsalandperformancecalendarisattached.2. AllrehearsalsandperformancesareMANDATORY.3. Studentswhomustmissarehearsalmustreporttheirabsencevia

http://www.hillgroveband.com/the-essentials/absence-request/

4. Absencesmustbereported2DAYSinadvance.5. Last-minuteabsencessuchasillnessorfamilyemergencyshouldbereportedtoMr.Erwinwithin

areasonabletimeframe.

6. Ifyouareabsentfromschool,pleasebringMr.Erwintheattendancenotethedayyoureturn.7. Absencesfromperformanceswillnotbepermittedexceptinthemostextenuatingcircumstances.8. Rehearsalsbeginontimeandwillendontime.Thestart/endtimeofrehearsalsDOESNOTinclude

traveltimeorsetupandstowingofequipment.Expectyourstudenttotake10-15minutestoprepareoneithersideofrehearsaltime.

9. BeingTardytorehearsalisonlypermittedfortutoring.Clubmeetingsarenotexcused.Youmustcommunicatewithyourclubsponsoryourobligationstotheensemble.

ATTENDANCECONSENQUENCES:

1. AbsenceswillbeEXCUSEDorUNEXCUSEDatthediscretionofthedirectors.AgeneralruletofollowisthatifCCSDwillexcuseit,sowillwe.

2. ANYUNEXCUSEDABSENCEduringtheweekoftheperformanceWILLresultinthestudentinquestionbeingsidelinedfortheupcomingperformance.

3. AfterAugust1st-THREEunexcusedabsencesinthecourseoftheresultwillresultinremovalfromtheensemble.

4. Ifyouaresidelined,youmuststillattendINUNIFORM.5. AnyinstanceofISSorOSSwillbeconsideredUNEXCUSED.Youmaynotattendrehearsalifyou

aresuspended.

6. UnexcusedtardieswillbemadeuppriortoorafterrehearsalBEFOREthefollowingperformance.

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MARCHINGBAND2018FALLCALENDAR

Monday Tuesday Wednesday Thursday Friday SaturdayJULY16SummerBand9-9

17SummerBand9-9

18SummerBand9-9

19SummerBand9-9

20SummerBand9-9

21

23SummerBand9-9

24SummerBand9-9

25SummerBand6-9(evening)



30SummerBandCookout&Celebration7pm

31

AUGUST1FirstDayofSchool!

2MB

4:30-7:30

3

4

6MB4-7 7MB

4:30-7:30

8 9MB

4:30-7:30

10 11MBMini-Camp9am-6pm

13MB4-7

14MB

4:30-7:30

15 16MB

4:30-7:3017HomevsDouglasCo.

18MBMini-Camp9am-6pm

20MB4-7 21MB4:30-7:30

22 23MB4:30-7:30

24Football@Pebblebrook

25

27MB4-7 28MB

4:30-7:30

29 30MB

4:30-7:30

31HomevsBanneker

SEPT1

3 No School – Labor Day

4MB

4:30-7:30

5 6MB

4:30-7:30

7MBMini-Camp4:30-9

8MBMini-Camp9am-6pm

10MB4-7 11MB

4:30-7:30

12 13MB4:30-

7:30

14Football@Etowah

15MBMini-Camp10am-6pm

17MB4-7 18MB

4:30-7:30

19 20MB

4:30-7:30

21HomevsSForsyth

22

24 25 26FALL 27BREAK 28 29

OCTOBER1MB4-7

2 MB 4:30-7:30

3 4MB4:30-7:30 5HomevsMcEachern

6BOAJSUContest

8MB4-7 9MB

4:30-7:30

10 11MB

4:30-7:3012FootballatKMHS

13MBMiniCamp9-6

15CobbExhibition

16NOMB 17 18MB

4:30-7:30

19FootballatNPaulding

20GSUContest

22MB4-7 23MB4:30-

7:30

24 25MB

4:30-7:30

26HomevsMarietta

27BOA@McEachernContest

29 30 31 NOVEMBER 1

2Football@NCobb

3

5 6NoSchool 7 8 9FootballPlayoffs(ifnecessary)

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12 13 14 15 16FootballPlayoffs(ifnecessary)

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HillgroveBandsBoosterAssociation,Inc.2018-2019ProjectedFundraisers

Sustainingaqualitybandprogramrequiressupportoverandabovethatwhichisprovidedthroughthe

instructionalprogramssupportedbytheCobbCountySchoolDistrict.Fundraisingisnecessarytomeettheseadditionalcosts.Inanefforttohelpmeettheneedsofthegeneralbandfundandtoassiststudents

inpaymentofbandfees,thefollowingfundraisersareprojectedforthe2018-2019SchoolYear.Some

fundraisersgodirectlytosupportthegeneralfund,whichbenefitsthebandasawhole.Otherfundraiserswillbedesignatedas100%bandfees(toassistwithstudentaccounts).Whileitisrealized

thatyouandyourstudent(s)maynotbeabletoparticipateinallfundraisers,thefollowinginformationisprovidedtoassistyouinplanning.Additionalfundraisersmaybeaddedshouldtheneedforadditional

fundsbeidentified.

Fundraiser ProjectedDateFundsapplied

toward

Scrip On-going 100%BandFees

Cookiedough August 100%BandFees

AnnualFundLetters BeginslateSpring 100%BandFees

ReviewingNewOptions SummerandEarlyFall 100%BandFees

March-A-Thon Fall 100%GeneralFund

Flocking On-going 100%GeneralFund

RestaurantNights On-going 100%GeneralFund

TasteofWestCobb April/May 100%GeneralFund

MiscellaneousHBBAInformation

OurBoosterisanon-profitorganizationwitha501C3fromtheIRS.Weoperatewithintherulesandregulations

setforthfromthisgroup,aswellasCobbCountySchoolDistrict’srulesforBoosterClubs.

WehaveBy-Laws,ElectedOfficers,CommitteeChairs,andoperatesolelytosupporttheeffortsoftheband

program.Weareheretomakethisprogramthebestwecanforthestudentswhoparticipateinbothconcertand

marchingbandaswellasguard.Volunteersareneededandappreciated!

CurrentElectedOfficersandCommitteeChairsarelistedonthebandwebsiteatwww.hillgroveband.com.Thisis

ourmainplaceforinformation,includingspiritwear,calendar,announcements,andrequirements,aswellasother

HBBAdetails.

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FINANCIALASSISTANCE

HBBAispreparedtoofferfinancialassistanceforthosefamilies/studentswhohavethegreatestneedforsupport.Wearesensitivetoeachfamily’sindividuallyuniquesituationandwillattempttodoallwecan

tohelp.

ToapplyforHBBAfinancialassistance,thefollowingisdueonorbeforeJune2ndforconsiderationforthe2018season:

1. Thisform,filledoutfully(incompleteapplicationswillnotbeconsidered),andsubmittedbyduedate.

2. AnessaywrittenbytheSTUDENTastowhytheywouldliketoparticipateinthemarchingband,whatbenefitsitwouldbringthempersonally,ANDwhattheywillbringtothegroup.

3. FamiliesMUSTagreetoparticipateinfundraisingactivitiestoreceiveHBBAfinancialassistance.Ifthisisnotsatisfied,financialassistancewillnotbeanoptionforfutureyears.

APPLICATIONFORFINANCIALASSISTANCE

StudentName:____________________________________ Grade:9101112Section/Instrument:_______________________________________ParentName(s):____________________________________________________________________________________EmailAddress(es):_________________________________________________________________________________PhoneNumber(s):_________________________________________________________________________________Weareapplyingforthefollowingassistancelevel(circle):

Upto80%TuitionAssistance PartialAssistance AlternatePaymentPlan(pleaseincludedetails/planrequested)

***BysigningbelowweacknowledgethatourfinancialsituationwillbereviewedbytheExecutiveBoardoftheHillgroveBandBoostersAssociationandthatwewillberequiredtoparticipateinfundraisingactivitiesofferedbyHBBAtosatisfyourfinancialassistanceagreement.ParentSignature:_________________________________________________Date:_________________________

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OPTIONALMEALSFORMARCHINGSEASON

• Dinnersduringsummerbandcamp(7daystotal)o Costis$8/meal/studenttocoverdinnereachnightoroptout(fulldetailsTBA)

• “FridayMeals”–dinneronfootballgamenight,CobbExhibition,etc.o Costis$8/studentforeachmeal.MealsfeatureChick-fil-a,Zaxby’s,Moe’s,PizzaNight,Sub

sandwiches,etc.Mealsincludeentre’,side,fruit/veggie,dessert,waterbottleandwillbeginonAugust17thforthefirstfootballgame.

o Details/scheduleexpectedfordistributionduringsummerbandcampwithpaymentdue

firstpartofAugust.Studentiswelcometobringtheirownmealfromhomeinlieuofpurchasingamealtoeatwiththegroup.

• “CompetitionMeals”–breakfast/lunch/dinneroptionsforcompetitionSaturdaysinOctober.o Costis$8/studentforeachmealforlunch/dinner

o MealinformationwillbedistributedwithoptionsforeachcompetitionbySeptemberandpaymentmustbereceivedbydeadlinetoparticipate.Studentiswelcometobringtheir

ownmealfromhomeinlieuofpurchasingamealtoeatwiththegroup.

***SPECIALNOTE***Wewilluseanewonlineticketsystemformealsthisyear.Sign-upformealswillbeonlineandpaymentwillbemadeonlineatthetimeofordering.Alinktosign-upformealswillbesharedforsummerbandcampASAP,andinfoforothermealswillbesharedduringsummerbandcamptocovertheseason.

*Details,price,schedulewillbedistributedoverthesummer.Paymentmustbereceivedforstudenttoparticipate.

6/1/17: Student Support *IFCB-3* Page 1 of 2

Form IFCB-3

“BLANKET”PERMISSIONTOPARTICIPATEINASERIESOFSCHOOL-SPONSOREDFIELDTRIPS

Student Information

StudentName:

DateofBirth:

Address:

HomePhone:

Incaseofemergency,notify:

Phone:

Insurance Information CompanyProvidingInsurance:

PolicyNumber:

NameofInsured:

GroupNumber:

Medical Information FamilyPhysician:

Phone:

Immunizations:

Doesthestudentneedtotakemedication? Yes NoIfso,whatmedication?

Previous operations or serious illnesses:

Special medical conditions:

Allergies? Yes No If yes, please identify allergy: Medication Food Stinging Insects Other

Please identify:

DietaryRestrictions:

Release

• I hereby request that (Student’s Name-PLEASE PRINT): ________________________________________ be allowed to participate in athletic team, band, orchestra, chorus, and/or any series of field trips related to one particular area of study or activity. I understand that transportation may or may not be provided by the Cobb County School District (District). In the event transportation is not provided by the District, transportation will be the student’s responsibility.

• Detailed trip information, including destination, date, time of departure, time of return, purpose, and supervision, should be given in writing to the parents at least two (2) weeks prior to each trip in the series.

• The District does have an indemnity plan pursuant to O.C.G.A. § 20-2-1090 that may or may not apply relative to the trip. Even if the plan covers some or all of the trip, the coverage amounts may not cover all injuries. I understand that as a parent I have the option of, and am encouraged to, purchase student insurance coverage either through the student accident insurance offered by the District or through my own insurance carrier.

• Ifanyemergencymedicalproceduresortreatmentarerequiredduringthetrip,Iconsenttothetripsupervisor(s)taking,arrangingfororconsentingtotheproceduresortreatmentinhis/herortheirdiscretion.

• Iagreetorelease,indemnify,andholdharmlessorreimbursetheCobbCountySchoolDistrict(District),itsBoardofEducation,anditsmembers,employees,agents,representatives,successorsorassignees,aswellasitsapprovedadulttripsupervisors(“DistrictIndemnitees”)fromandforeverpromisenottosuethemonanyandallclaims,demands,rights,causesofaction,liabilities,losses,damages,costsandexpenses(includingreasonableattorneys’fees),whetherknownorunknown,thatI,anyotherparentorguardianoftheabove-namedstudent,thestudentoranyothersuccessororassigneemayhaveormayallegetohaveagainsttheDistrictIndemniteesorwhichmaybebroughtagainsttheDistrictIndemniteesarisingoutoforinanymannerrelatingtothestudent’sparticipationinthefieldtrips,includingbutnotlimitedanylosses,damagesorinjuriesortotherenderingofemergencymedicalproceduresortreatment.

6/1/17: Student Support *IFCB-3* Page 2 of 2

NOTE: This form must be signed by student if the student is 18 years of age or older.

Name of Parent/Guardian (PLEASE PRINT) Signature of Parent/Guardian Date

1/1/13: Student Support *JG1-1* Page 1 of 1

Form JG(1)-1

Empowering Dreams for the Future

PERMISSION TO DISPLAY STUDENT PHOTOGRAPH/NAME I hereby grant permission to Cobb County School District (District) to use or publicly display my child’s photograph, video image, or audio clip on the District’s Web site(s), individual school Web pages, or in other official District publications without further notice. I acknowledge the District's right to crop, edit, or treat the photograph, video, or audio clip at its discretion. I also understand that once my student’s photograph, video image, or audio clip is published on a Web site, it can be downloaded by any computer user, on or off campus. I understand a student’s name may be published along with the student’s picture. Therefore, I agree to indemnify, defend and hold harmless the members of the Cobb County Board of Education, the District, its officers, employees, agents, successors and assignees (the "Indemnified Parties") from and against any and all claims and liabilities resulting from this publishing. Subject/Nature of Event: Marching Band Season: Fall 2018

Permission is granted for the use requested above. NOTE: This form must be signed by student if the student is 18 years of age or older.

Name of Student Signature of Student Date of Student Signature

Name of Parent/Guardian Signature of Parent/Guardian Date of Parent/Guardian Signature(s)

Cobb County School District 2018-2019 School Year

ATHLETIC PARTICIPATION, WAIVER, INSURANCE, AND CONSENT FORM *Parent/Guardian(s) and Student signature required at bottom of form & initials required as indicated below

PLEASE PRINT

Student Name________________________________________________________________________ _______________ (Last) (First) (Middle) (Grade Level 2017-18)

Address ______________________________________________________________________________________________ (Street) (City) (Zip)

_________________________ _________________________ __________________ _______________ (Parent Cell Phone #) (Parent Alternate Phone #) (Year Entered 9th Grade) (Date of Birth)

PARENT/GUARDIAN CONSENT FOR ATHLETIC PARTICIPATION

*Parent/Guardian and Student must both initial in blanks before each bold section below

__________ __________ ACKNOWLEDGEMENT OF RISK: I understand and acknowledge that participation in inter- Parent/Guardian Student scholastic sports teams/clubs and events is voluntary and by its very nature possesses an actual or potential risk of emotional and physical injury/illness, which may range in severity from minor to long term catastrophic injury, up to permanent paralysis or death. While it is not possible to eliminate this risk, Students have the responsibility to help reduce the chance of injury. Students must obey all safety rules, report all physical problems to their coaches or supervisors follow a proper conditioning program and inspect equipment daily. Parents/Guardians or Students who do not wish to accept this risk should not sign this form.

__________ __________ INSURANCE COVERAGE: I am aware there is no District insurance coverage for medical Parent/Guardian Student treatment of personal injuries or property damage which may arise out of Student’s participation in inter-scholastic athletics, sports clubs and events. I understand my Student must have insurance coverage in order to participate.

Please CHECK one of the following statements regarding insurance coverage for Student for the current school year:

____ Student is adequately and currently covered by accident insurance that will cover injuries sustained while participating in inter-scholastic athletics, sports teams/clubs and events.

Insurance Company: ______________________________________ Company Phone Number: ________________________________ Name of Insured: _________________________________________ Policy Number: ________________________________________

____ I wish to purchase the Benefit Plan provided by the Cobb County School System. (A copy of this Benefit Plan should be attached)

__________ __________ PHYSICAL EVALUATION AND MEDICAL TREATMENT: Per Georgia High School Parent/Guardian Student Association (GHSA) a Pre-participation Physical Evaluation must be performed by a physician (MD/DO), nurse practitioner or physician assistant to medically screen each student who participates in District athletic programs. I understand that this medical evaluation is general in nature and only performed for purpose of determining fitness for athletics. In case of an emergency or accident on/off school grounds during any school activity or athletic event, which in the opinion of school authorities requires immediate medical or surgical attention, I hereby grant permission to physicians, consulting physicians, certified athletic trainers, emergency medical technicians, and other healthcare providers selected by school authorities to provide medical care and treatment (including hospitalization if deemed appropriate) unless I am present and request otherwise or until I later request otherwise.

__________ __________ REVIEW OF ATHLETIC HANDBOOK (including Board Policy IDF-R Athletic Code of Parent/Guardian Student Conduct): I acknowledge that I have reviewed and consent to the guidelines of the Student/Parent Athletic Handbook, which can be found on the Athletics page of the Cobb County School District website (cobbk12.org), the local high school website, or by request of a hardcopy to the local high school. I understand that both Student and Parent/Guardian are subject to the rules outlined in this handbook and that violations may result in school discipline and consequences up to Student’s loss of the privilege of athletic participation and/or loss of Parent(s)’/Guardian(s)’ privilege of attending athletic events. I have read and understand the consequences of certain behavior(s) as outlined in the Code of Conduct.

________ _____ TRANSPORTATION AND TRAVEL: I acknowledge my understanding of the travel-related Parent/Guardian Student guidelines as outlined within the Student/Parent Athletic Handbook, including the responsibility of parent/guardian to arrange transportation when not District-provided. I consent for my Student to participate in school-sponsored athletic trips.

__________ _________ WAIVER: I assume all liability and responsibility for any and all potential or real risks, injuries or Parent/Guardian Student even death which may result from Student’s participation in inter-scholastic athletics, sports teams/clubs and events. I represent and warrant that I know of no mental or physical condition that would make it unsafe for Student to participate in inter-scholastic athletics, sports teams/clubs and events. I understand, acknowledge, and agree that the Cobb County School District (CCSD) shall not be liable for any injury/illness suffered by the Student which arises out of and/or is associated with preparing for and/or participating in inter-scholastic athletics, sports teams/clubs and events.

I hereby release, discharge, indemnify, and agree to hold harmless the CCSD District, Members of the CCSD Board of Education, its past, present and future officers, attorneys, agents, employees, predecessors and successors in interest, and assigns, hereinafter “CCSD releasees”, from any and all liability arising out of or in connection with Student’s participation in inter-scholastic athletics, sports teams/clubs and events. For purpose of this Release, liability means all claims, demands, losses, causes of action, suits, or judgments of any kind that Student or Student’s parents, guardians, heirs, executors, administrators, and assigns have or may have against the CCSD releasees because of Student’s personal, physical, or emotional injury, accident, illness or death, or because of any loss of or damage to property that occurs to Student or his or her property during Student’s participation in inter-scholastic athletics, sports teams/clubs and events due to acts of passive or active negligence by CCSD releases other than actions involving fraud or actual malice.

By signing below, you acknowledge that you have carefully read this voluntary Waiver and understand the potential dangers incident to engaging in inter-scholastic athletics, sports teams/clubs and events, and are fully aware of the legal consequences of this agreement.

SIGNATURE: By signing below, Parent/Guardian and Student hereby agree to/give consent for participation in inter-scholastic athletics, sports teams/clubs and events for Cobb County School District of the below-indicated Student. You acknowledge that you have carefully reviewed and agree to all terms of athletic participation, including the voluntary waiver, verify that all information contained herein is accurate, and understand that any false information may result in Student’s ineligibility for athletic participation.

____________________________________ ____________________________________ ____________ Signature(s) of Parent(s)/Guardian(s) Printed Name of Parent(s)/Guardian(s) Date

____________________________________ ____________________________________ ____________ Signature of Student Printed Name of Student Date

■ Preparticipation Physical Evaluation HISTORY FORM

(Note: This form is to be filled out by the patient and parent prior to seeing the physician. The physician should keep this form in the chart.)

Date of Exam ___________________________________________________________________________________________________________________

Name __________________________________________________________________________________ Date of birth __________________________

Sex _______ Age __________ Grade _____________ School _____________________________ Sport(s) __________________________________

Medicines and Allergies: Please list all of the prescription and over-the-counter medicines and supplements (herbal and nutritional) that you are currently taking

Do you have any allergies? � Yes � No If yes, please identify specific allergy below. � Medicines � Pollens � Food � Stinging Insects

Explain “Yes” answers below. Circle questions you don’t know the answers to.

GENERAL QUESTIONS Yes No

1. Has a doctor ever denied or restricted your participation in sports for any reason?

2. Do you have any ongoing medical conditions? If so, please identify below: � Asthma � Anemia � Diabetes � InfectionsOther: _______________________________________________

3. Have you ever spent the night in the hospital?

4. Have you ever had surgery?

HEART HEALTH QUESTIONS ABOUT YOU Yes No5. Have you ever passed out or nearly passed out DURING or

AFTER exercise?

6. Have you ever had discomfort, pain, tightness, or pressure in your chest during exercise?

7. Does your heart ever race or skip beats (irregular beats) during exercise?

8. Has a doctor ever told you that you have any heart problems? If so, check all that apply: � High blood pressure � A heart murmur� High cholesterol � A heart infection� Kawasaki disease Other: _____________________

9. Has a doctor ever ordered a test for your heart? (For example, ECG/EKG, echocardiogram)

10. Do you get lightheaded or feel more short of breath than expected during exercise?

11. Have you ever had an unexplained seizure?

12. Do you get more tired or short of breath more quickly than your friends during exercise?

HEART HEALTH QUESTIONS ABOUT YOUR FAMILY Yes No13. Has any family member or relative died of heart problems or had an

unexpected or unexplained sudden death before age 50 (including drowning, unexplained car accident, or sudden infant death syndrome)?

14. Does anyone in your family have hypertrophic cardiomyopathy, Marfan syndrome, arrhythmogenic right ventricular cardiomyopathy, long QT syndrome, short QT syndrome, Brugada syndrome, or catecholaminergic polymorphic ventricular tachycardia?

15. Does anyone in your family have a heart problem, pacemaker, or implanted defibrillator?

16. Has anyone in your family had unexplained fainting, unexplained seizures, or near drowning?

BONE AND JOINT QUESTIONS Yes No17. Have you ever had an injury to a bone, muscle, ligament, or tendon

that caused you to miss a practice or a game?

18. Have you ever had any broken or fractured bones or dislocated joints?

19. Have you ever had an injury that required x-rays, MRI, CT scan, injections, therapy, a brace, a cast, or crutches?

20. Have you ever had a stress fracture?

21. Have you ever been told that you have or have you had an x-ray for neck instability or atlantoaxial instability? (Down syndrome or dwarfism)

22. Do you regularly use a brace, orthotics, or other assistive device?

23. Do you have a bone, muscle, or joint injury that bothers you?

24. Do any of your joints become painful, swollen, feel warm, or look red?

25. Do you have any history of juvenile arthritis or connective tissue disease?

MEDICAL QUESTIONS Yes No26. Do you cough, wheeze, or have difficulty breathing during or

after exercise?

27. Have you ever used an inhaler or taken asthma medicine?

28. Is there anyone in your family who has asthma?

29. Were you born without or are you missing a kidney, an eye, a testicle (males), your spleen, or any other organ?

30. Do you have groin pain or a painful bulge or hernia in the groin area?

31. Have you had infectious mononucleosis (mono) within the last month?

32. Do you have any rashes, pressure sores, or other skin problems?

33. Have you had a herpes or MRSA skin infection?

34. Have you ever had a head injury or concussion?

35. Have you ever had a hit or blow to the head that caused confusion, prolonged headache, or memory problems?

36. Do you have a history of seizure disorder?

37. Do you have headaches with exercise?

38. Have you ever had numbness, tingling, or weakness in your arms or legs after being hit or falling?

39. Have you ever been unable to move your arms or legs after being hit or falling?

40. Have you ever become ill while exercising in the heat?

41. Do you get frequent muscle cramps when exercising?

42. Do you or someone in your family have sickle cell trait or disease?

43. Have you had any problems with your eyes or vision?

44. Have you had any eye injuries?

45. Do you wear glasses or contact lenses?

46. Do you wear protective eyewear, such as goggles or a face shield?

47. Do you worry about your weight?

48. Are you trying to or has anyone recommended that you gain or lose weight?

49. Are you on a special diet or do you avoid certain types of foods?

50. Have you ever had an eating disorder?

51. Do you have any concerns that you would like to discuss with a doctor?

FEMALES ONLY52. Have you ever had a menstrual period?

53. How old were you when you had your first menstrual period?

54. How many periods have you had in the last 12 months?

Explain “yes” answers here

I hereby state that, to the best of my knowledge, my answers to the above questions are complete and correct.

Signature of athlete __________________________________________ Signature of parent/guardian ____________________________________________________________ Date _____________________

©2010 American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine. Permission is granted to reprint for noncommercial, educational purposes with acknowledgment.HE0503 9-2681/0410

■ Preparticipation Physical Evaluation THE ATHLETE WITH SPECIAL NEEDS: SUPPLEMENTAL HISTORY FORM

Date of Exam ___________________________________________________________________________________________________________________


Sex _______ Age __________ Grade _____________ School _____________________________ Sport(s) __________________________________

1. Type of disability

2. Date of disability

3. Classification (if available)

4. Cause of disability (birth, disease, accident/trauma, other)

5. List the sports you are interested in playing

Yes No6. Do you regularly use a brace, assistive device, or prosthetic?

7. Do you use any special brace or assistive device for sports?

8. Do you have any rashes, pressure sores, or any other skin problems?

9. Do you have a hearing loss? Do you use a hearing aid?

10. Do you have a visual impairment?

11. Do you use any special devices for bowel or bladder function?

12. Do you have burning or discomfort when urinating?

13. Have you had autonomic dysreflexia?

14. Have you ever been diagnosed with a heat-related (hyperthermia) or cold-related (hypothermia) illness?

15. Do you have muscle spasticity?

16. Do you have frequent seizures that cannot be controlled by medication?


Please indicate if you have ever had any of the following.

Yes NoAtlantoaxial instability

X-ray evaluation for atlantoaxial instability

Dislocated joints (more than one)

Easy bleeding

Enlarged spleen

Hepatitis

Osteopenia or osteoporosis

Difficulty controlling bowel

Difficulty controlling bladder

Numbness or tingling in arms or hands

Numbness or tingling in legs or feet

Weakness in arms or hands

Weakness in legs or feet

Recent change in coordination

Recent change in ability to walk

Spina bifida

Latex allergy


I hereby state that, to the best of my knowledge, my answers to the above questions are complete and correct.

Signature of athlete __________________________________________ Signature of parent/guardian __________________________________________________________ Date _____________________

©2010 American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine. Permission is granted to reprint for noncommercial, educational purposes with acknowledgment.

■ Preparticipation Physical Evaluation PHYSICAL EXAMINATION FORM


PHYSICIAN REMINDERS1. Consider additional questions on more sensitive issues

• Do you feel stressed out or under a lot of pressure?• Do you ever feel sad, hopeless, depressed, or anxious?• Do you feel safe at your home or residence?• Have you ever tried cigarettes, chewing tobacco, snuff, or dip?• During the past 30 days, did you use chewing tobacco, snuff, or dip?• Do you drink alcohol or use any other drugs?• Have you ever taken anabolic steroids or used any other performance supplement?• Have you ever taken any supplements to help you gain or lose weight or improve your performance?• Do you wear a seat belt, use a helmet, and use condoms?

2. Consider reviewing questions on cardiovascular symptoms (questions 5–14).

EXAMINATIONHeight Weight � Male � Female

BP / ( / ) Pulse Vision R 20/ L 20/ Corrected � Y � NMEDICAL NORMAL ABNORMAL FINDINGSAppearance• Marfan stigmata (kyphoscoliosis, high-arched palate, pectus excavatum, arachnodactyly,

arm span > height, hyperlaxity, myopia, MVP, aortic insufficiency)Eyes/ears/nose/throat• Pupils equal• HearingLymph nodesHeart a

• Murmurs (auscultation standing, supine, +/- Valsalva)• Location of point of maximal impulse (PMI)Pulses• Simultaneous femoral and radial pulsesLungsAbdomenGenitourinary (males only)b

Skin• HSV, lesions suggestive of MRSA, tinea corporisNeurologic c

MUSCULOSKELETALNeckBackShoulder/armElbow/forearmWrist/hand/fingersHip/thighKneeLeg/ankleFoot/toesFunctional• Duck-walk, single leg hop

aConsider ECG, echocardiogram, and referral to cardiology for abnormal cardiac history or exam.bConsider GU exam if in private setting. Having third party present is recommended. cConsider cognitive evaluation or baseline neuropsychiatric testing if a history of significant concussion.

��Cleared for all sports without restriction

��Cleared for all sports without restriction with recommendations for further evaluation or treatment for _________________________________________________________________

____________________________________________________________________________________________________________________________________________

��Not cleared

��Pending further evaluation

��For any sports

��For certain sports _____________________________________________________________________________________________________________________

Reason ___________________________________________________________________________________________________________________________

Recommendations _________________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________________________________

I have examined the above-named student and completed the preparticipation physical evaluation. The athlete does not present apparent clinical contraindications to practice and participate in the sport(s) as outlined above. A copy of the physical exam is on record in my office and can be made available to the school at the request of the parents. If condi-tions arise after the athlete has been cleared for participation, the physician may rescind the clearance until the problem is resolved and the potential consequences are completely explained to the athlete (and parents/guardians).

Name of physician (print/type) _____________________________________________________________________________________________________ Date ________________

Address ___________________________________________________________________________________________________________ Phone _________________________

Signature of physician _______________________________________________________________________________________________________________________, MD or DO

©2010 American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine. Permission is granted to reprint for noncommercial, educational purposes with acknowledgment.HE0503 9-2681/0410

■ Preparticipation Physical Evaluation CLEARANCE FORM

Name ___ ____________________________________________________ Sex ��M ��F Age _________________ Date of birth _________________

��Cleared for all sports without restriction

��Cleared for all sports without restriction with recommendations for further evaluation or treatment for _______________________________________________

___________________________________________________________________________________________________________________________

��Not cleared

��Pending further evaluation

��For any sports

��For certain sports _____________________________________________________________________________________________________

Reason ___________________________________________________________________________________________________________

Recommendations _______________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

I have examined the above-named student and completed the preparticipation physical evaluation. The athlete does not present apparent clinical contraindications to practice and participate in the sport(s) as outlined above. A copy of the physical exam is on record in my office and can be made available to the school at the request of the parents. If conditions arise after the athlete has been cleared for participation, the physician may rescind the clearance until the problem is resolved and the potential consequences are completely explained to the athlete (and parents/guardians).

Name of physician (print/type) ___________________________________________________________________________________ Date ________________

Address _________________________________________________________________________________________ Phone _________________________

Signature of physician _____________________________________________________________________________________________________, MD or DO

EMERGENCY INFORMATION

Allergies ______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

Other information _______________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

©2010 American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine. Permission is granted to reprint for noncommercial, educational purposes with acknowledgment.

STUDENT/PARENT CONCUSSION AWARENESS FORM SCHOOL: __________________________________________________________________________ DANGERS OF CONCUSSION Concussions at all levels of sports have received a great deal of attention and a state law has been passed to address this issue. Adolescent athletes are particularly vulnerable to the effects of concussion. Once considered little more than a minor “ding” to the head, it is now understood that a concussion has the potential to result in death, or changes in brain function (either short-term or long-term). A concussion is a brain injury that results in a temporary disruption of normal brain function. A concussion occurs when the brain is violently rocked back and forth or twisted inside the skull as a result of a blow to the head or body. Continued participation in any sport following a concussion can lead to worsening concussion symptoms, as well as increased risk for further injury to the brain, and even death. Player and parental education in this area is crucial – that is the reason for this document. Refer to it regularly. This form must be signed by a parent or guardian of each student who wishes to participate in GHSA athletics. One copy needs to be returned to the school, and one retained at home. COMMON SIGNS AND SYMPTOMS OF CONCUSSION

Headache, dizziness, poor balance, moves clumsily, reduced energy level/tiredness Nausea or vomiting Blurred vision, sensitivity to light and sounds Fogginess of memory, difficulty concentrating, slowed thought processes, confused about surroundings or game

assignments Unexplained changes in behavior and personality Loss of consciousness (NOTE: This does not occur in all concussion episodes.)

BY-LAW 2.68: GHSA CONCUSSION POLICY: In accordance with Georgia law and national playing rules published by the National Federation of State High School Associations, any athlete who exhibits signs, symptoms, or behaviors consistent with a concussion shall be immediately removed from the practice or contest and shall not return to play until an appropriate health care professional has determined that no concussion has occurred. (NOTE: An appropriate health care professional may include, licensed physician (MD/DO) or another licensed individual under the supervision of a licensed physician, such as a nurse practitioner, physician assistant, or certified athletic trainer who has received training in concussion evaluation and management.

a) No athlete is allowed to return to a game or a practice on the same day that a concussion (a) has been diagnosed, OR (b) cannot be ruled out.

b) Any athlete diagnosed with a concussion shall be cleared medically by an appropriate health care professional prior to resuming participation in any future practice or contest. The formulation of a gradual return to play protocol shall be a part of the medical clearance.

c) It is mandatory that every coach in each GHSA sport participate in a free, online course on concussion management prepared by the NFHS and available at www.nfhslearn.com at least every two years – beginning with the 2013-2014 school year.

d) Each school will be responsible for monitoring the participation of its coaches in the concussion management course, and shall keep a record of those who participate.

I HAVE READ THIS FORM AND I UNDERSTAND THE FACTS PRESENTED IN IT. SIGNED: ______________________________ _______________________________ (Student) (Parent or Guardian) DATE: __________________________

Marching Band Package 2018 Season - …€¦ · 2 MARCHING BAND MEMBERSHIP CONTRACT 2018 SEASON...

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Transcript of Marching Band Package 2018 Season - …€¦ · 2 MARCHING BAND MEMBERSHIP CONTRACT 2018 SEASON...