Register For Franklin Central Bands

This form is required for all members of the marching band, indoor percussion, and winter guard programs.

Student

First Name

Last Name

Phone Number

Address

State

City

Zip

Student Grade

Graduation Year

Instrument Played in Band Class

Group

School

Birthday

T-Shirt Size

Emergency Phone

Primary Care Physician (PCP) Name

PCP Phone #

Insurance Company Name

Allergies

Routine Medication

Health Concerns (conditions or disabilities)

I give permission for the chaperones, staff or parent volunteers to provide over the counter medication to my child.

Over the counter medication exclusions?

I hereby give permission for emergency treatment of my child and understand I will be responsible for all charges not covered by insurance.

Date of medical consent authorization

Guardian 1

First Name

Last Name

Phone Number

Volunteer Preference

Volunteer Preference Additional Write-in/Other

CDL License

If no CDL, do you have an interest in earning one?

Have you completed the FTCSC SafeVisitor background check?

I give permission for the chaperones, staff or parent volunteers to provide over the counter medication to my child.

I hereby give permission for emergency treatment of my child and understand I will be responsible for all charges not covered by insurance.

Guardian 2

First Name

Last Name

Phone Number

Volunteer Preference

Volunteer Preference Additional Write-in/Other

CDL License

If no CDL, do you have an interest in earning one?

Have you completed the FTCSC SafeVisitor background check?

Guardian 3

First Name

Last Name

Phone Number

Volunteer Preference

Volunteer Preference Additional Write-in/Other

CDL License

If no CDL, do you have an interest in earning one?

Have you completed the FTCSC SafeVisitor background check?

Franklin Central Bands

Franklin Central Bands

Register For Franklin Central Bands

Student

Guardian 1

Guardian 2

Guardian 3

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