2018-2019 NBHS Blackhawk Band Registration
Student
*
First Name
Last Name
Student Email
*
example@example.com
Student Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Student Cell Phone Number
*
-
Area Code
Phone Number
Student's Cell Carrier
*
Verizon
US Cellular
AT&T
Sprint
Other
Student's Birthday
*
-
Month
-
Day
Year
Date
Grade
*
8th
Freshman
Sophomore
Junior
Senior
What do you plan on participating in (Select all that apply):
*
Marching Band
Concert Band
Wind Ensemble
Guard
Instrument/Guard (Select all that apply)
*
Flute
Piccolo
Clarinet
Bass Clarinet
Bassoon
Trumpet
Alto Saxophone
Tenor Saxophone
Trombone
Mellophone (French Horn)
Euphonium (Baritone)
Sousaphone (Tuba)
Front Ensemble
Oboe
Drumline
Guard
Will the student be using a school instrument?
*
Yes
No
Parent or Legal Guardian
*
First Name
Last Name
Parent or Legal Guardian Email
*
example@example.com
Parent or Legal Guardian Address (If different from students)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent or Legal Guardian Cell Phone
*
-
Area Code
Phone Number
Parent or Legal Guardian Cell Carrier
*
Verizon
US Cellular
ATT
Sprint
Other
Texting is an important method of our communication. Do you wish to participate in the texting service?
*
Yes
No
Second Parent or Legal Guardian If Applicable
First Name
Last Name
Second Parent or Legal Guardian If Applicable Email
example@example.com
Second Parent or Legal Guardian If Applicable Address (If different from students)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Second Parent or Legal Guardian If Applicable Cell Phone
-
Area Code
Phone Number
Second Parent or Legal Guardian If Applicable Cell Carrier
Verizon
US Cellular
ATT
Sprint
Other
Texting is an important method of our communication. Do you wish to participate in the texting service?
Yes
No
Volunteering can help you reduce your fees! If you are planning on volunteering please select which committee/s that you are interested in:
Membership Committee (Volunteer Coordinator)
Publicity Committee
Hospitality Commitee (Meals Committee, Events Committee, Band Banquet Committee, and/or Senior Recognition Committee)
Ways and Means Committee (US Cellular Center, Basketball Concessions, BBQ/Flea Market, and/or 4th of July Booth)
Band Operations (MIB - Men in Black)
Uniform Committee (Uniform Alterations, Football Games, and/or Competions)
Logistics Committee (Fleet Management)
Waiver: In consideration of my participation in the North Buncombe Blackhawk Band, I for myself, my heirs, and assigns, hereby release Buncombe County Board of Education, sponsors, volunteers, and employees of these activities for any and all liability arising from illness and damages I may suffer as a result of participation in such events. I attest that I am physically fit, have insurance, and I am aware that participation in these events could, in some circumstances, result in severe physical injury or death. I hereby expressly recognize that this Release of Liability, Waiver of Legal Rights, and Assumption of Risk is a contract pursuant to which I have released any and all claims against the Released Parties resulting from any injury, or death, sustained from participation in North Buncombe Blackhawk Band activities including any claims for negligence of the Released Parties.
*
I Agree
Student Signature (For Participation in the North Buncombe Blackhawk Band)
*
Parent/Guardian Signature (For Participation in the North Buncombe Blackhawk Band)
*
List your current health insurance provider below. Insurance Carrier:
*
Policy Holder:
*
Policy #:
*
PARENTAL PERMISSION FOR USE OF STUDENT PHOTOGRAPHY, LIKENESS AND/OR VOICE FOR SCHOOL/BAND
This form is used to establish parental permission for student participation in areas where pictures are taken, voices are recorded, and/or videos are made. Please call your school if you have any questions.I, {parentOr} parent or legal guardian of {student} hereby grant permission to North Buncombe High School/North Buncombe Band Boosters to use my child’s photograph, likeness, and/or voice in any way that would reasonably portray programs of North Buncombe High School/North Buncombe Bands. This includes pictures/videos in the yearbook, pictures/videos taken in the classroom or on field trips, athletic events, school programs, school/booster websites, etc. I further release North Buncombe High School/North Buncombe Band Boosters, and any of its employees or agents, from any damages in using my child’s photograph, likeness, and/or voice. I do further certify that I am of full legal capacity to execute the above authorization and release.
*
I Agree
Parent/Guardian Signature (For PARENTAL PERMISSION FOR USE OF STUDENT PHOTOGRAPHY, LIKENESS AND/OR VOICE FOR SCHOOL/BAND)
*
Blackhawk Band Medical Information Form
Does Student have a medical condition we need to be aware of?
*
If none enter NO.
Prescription medication we need to be aware of. Please indicate medication, dose, frequency taken and route of method taken. (orally, by inhalation, or injection):
*
If none enter NO.
Over The Counter Medication. Please indicate if student takes any non-prescription medications routinely:
*
If none enter NO.
Allergies (non-food related)
*
If none enter NO.
Does Student have any specific food requirements/allergies? (Gluten free, vegetarian, allergic to peanuts, etc.):
*
If none enter NO.
Parent/Guardian Signature (For Blackhawk Band Medical Information Form)
*
Authorization for Emergency Medical Care and Disbursement of Over the Counter Medication
My son/daughter/student has permission to take over-the-counter medications needed to treat a minor illness while on a band trip. Every effort will be made to communicate with the parent/guardian, treatment needs and results while on a trip. Should the need for more extensive treatment arise, the student will be taken to an appropriate medical facility. I hereby give my permission to the adult leadership of the North Buncombe Band Boosters to secure and authorize emergency medical treatment should my child become seriously ill or injured. I understand that every effort will be made to contact me in case of emergency. My child may be given any of the over the counter medications indicated by Selecting below if necessary:
*
TYLENOL(ACETAMINOPHEN):
ADVIL(IBUPROFEN):
DECONGESTANT:
MIDOL:
TUMS:
BENADRYL:
IMODIUM:
DRAMAMINE:
LIQUID ZYRTEC (CETIRIZINE):
I understand that it is my responsibility to inform the North Buncombe Band Boosters of any changes in my student’s medication by requesting and completing a new medical form.
*
I Agree
Parent/Guardian Signature (For Authorization for Emergency Medical Care and Disbursement of Over the Counter Medication)
*
Drug, Alcohol, and Behavior Responsibility Clause:
In compliance with Buncombe County school policies, during any event or trip sponsored by the North Buncombe Band or North Buncombe Band Boosters, if my child:
*
1) Acts in a manner which endangers his/her life or the life of another person.
2) Has in his/her possession drugs, alcohol or tobacco.
3) Is in possession of any concealed weapons, i.e. Pocket knives, or knives of any kind, guns of any kind, etc.
4) Repeatedly disobeys the rules of the group.
I understand that the adult leadership may contact me at any hour of the day or night to arrange for the immediate return home of my student. Any additional costs incurred to accommodate the student’s home transport is payable by me.
I understand that all school policies/rules apply at all times, including the Buncombe County school dress code. I acknowledge that I will be financially held responsible for any damages caused by my child’s misconduct or actions.
I understand that my student’s phone number will be in possession of their chaperone during any out of town trips.
Student Signature (Agreeing to Drug, Alcohol, and Behavior Responsibility Clause)
Parent/guardian Signature (Agreeing to Drug, Alcohol, and Behavior Responsibility Clause)
2018-2019 Blackhawk Band Student Fee Agreement Form
Your son/daughter/student has elected to participate in the North Buncombe High School Band program. By electing to participate each student and parent/guardian acknowledge to abide by the fee requirements adopted by the North Buncombe Band Boosters. These fees cover costs associated with musical score development, instruction, drill, band camp instruction, concert camp instruction, transportation costs for any band related trip away from NBHS, food and lodging costs for overnight trips, uniforms and associated repairs, costs to move band equipment from NBHS to band related events. Band fees are contingent on the operations budget, fundraising and the number of students participating. There may be additional fees related to certain trips or functions that are not covered by the budget. These additional costs will be communicated in a timely manner thru the North Buncombe Band Boosters. Any damage beyond normal wear and tear, to instruments and/or equipment not owned by a student, will be the responsibility of the Parents/Guardians.The cost per student is $715.00 for full year high school students, and $613 for color guard, 8th graders and STEM marchers,. You can reduce this amount that you owe by volunteering at various events/activities. Each hour that you volunteer will credit your child’s account by $15.00 with a maximum of 15 hours for High School students (10 hours required during fall marching season 5 hours during spring concert season), and 10 hours (all required during fall marching season) for color guard, 8th grade marchers and STEM marchers. This volunteer commitment reduces the requisite fee to $490.00 for full year high school students, and $375.00 for color guard, 8th graders and STEM marchers. Non-marcher fees (meaning the student participates in either Concert Band or Wind Ensemble alone) are $100.00. There are no volunteer options for a non-marcher. The payment structure for year round High School students WITH volunteer hours is as follows: *$50.00 to be paid at the mandatory registration meeting on May 31, 2018 (upcoming 9th graders) or June 1, 2018 (upcoming 10th-12th graders).*ALL past due fees must be paid in full by June 30th to ensure that your student has a place in the drill. *$150.00 to be paid by the first day of your child’s band camp (either percussion/guard or rookie/ full band). If this amount has not been paid, your child will be dismissed from camp and not allowed to return until money is paid. *$145.00 due by August 15th. *$145.00 due by September 15th. If you choose NOT to volunteer, use the following payment schedule for full time High School students: *$50.00 to be paid at the mandatory registration meeting on May 31, 2018 (upcoming 9th graders) or June 1, 2018 (upcoming 10th-12th graders). *ALL past due fees must be paid in full by June 30th to ensure that your student has a place in the drill. *$225.00 to be paid by the first day of your child’s band camp (either percussion/guard or rookie/full band). If this amount has not been paid, your child will be dismissed from camp and not allowed to return until money is paid. *$220.00 due by August 15th. *$220.00 due by September 15th. The payment structure for Color guard, 8th graders and STEM marchers WITH volunteer hours is: *$50.00 to be paid at the mandatory registration meeting on May 31, 2018 (upcoming 8th-9th graders) or June 1, 2018 (upcoming 10th-12th graders). *ALL past due fees must be paid in full by June 30th to ensure that your student has a place in the drill. *$110.00 to be paid by the first day of your child’s band camp (either percussion/guard or rookie/full band). If this amount has not been paid, your child will be dismissed from camp and not allowed to return until money is paid. *$110.00 due by August 15th. *$105.00 due by September 15th. If you choose NOT to volunteer, please use the following payment schedule for Color guard, 8th graders and STEM marchers: *$50.00 to be paid at the mandatory registration meeting on May 31, 2018 (upcoming 8th-9th graders) or June 1, 2018 (upcoming 10th-12th graders) *$190.00 to be paid by the first day of your child’s band camp (either percussion/guard or rookie/full band). If this amount has not been paid, your child will be dismissed from camp and not allowed to return until money is paid. *$190.00 due by August 15th. *$170.00 due by September 15th. All volunteers must be sure that their hours are registered with the Volunteer Coordinator in order to qualify for the discounted student fee. If your student is a non-marcher, please use the following payment schedule. *$50.00 to be paid at the mandatory registration meeting on May 31, 2018 (upcoming 9th graders) or June 1, 2018 (upcoming 10th-12th graders). ALL past due fees must be paid in full by the first day of school. *$50.00 due by September 15th. For anyone that feels they should be exempt for a particular reason, they shall submit in writing a reasonable cause to the Booster Executive Committee and the Band Director for review. A decision will be provided to the requestor regarding each request. These fees are to be paid to the Band Boosters of North Buncombe High School per the schedule above. A monthly statement will be provided to you from the Band Booster Treasurer, Ella Vrolyk. Methods of payments are as follows: *Checks payable to NBBB may be submitted to: North Buncombe Band Boosters PO Box 1175 Weaverville NC 28787. *Cash or checks may be submitted to the Band Treasurer, Ella Vrolyk, either directly or via the wooden payment drop box mounted to the wall in the NBHS Band Room. A $35.00 fee will be charged for any returned checks, and could result in cash only payments being required. NBBB not responsible for cash sent via students. Please use a sealed envelope and clearly indicate the student’s name on all payments. If band fees are not paid in full, then subsequent band trips or other functions could be cancelled, as registration, transportation, etc. is paid in advance. Likewise, failure to pay band fees may result in your student's removal from marching competition events. By signing this agreement I understand the above information and agree to pay the band fees. I acknowledge that failure to pay band fees will result in my child participating in only the Buncombe County School funded activities.
I Agree
Parent/Guardian Signature (Agreeing to Fees)
2019-2020 Blackhawk Band Student Fee Agreement Form
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