High School Honor Groups – Payment & Acceptance of Membership

High School Honor Groups - Acceptance 2019 (Deadline: December 28, 2018)

Congratulations again on being selected to represent your family, music group, school, and community by being a member of an All-Southern California Honor Group.

The responsibility of membership in an Honor Group goes far beyond just excellent musical skills. Your responsibility extends to making every effort to ensure this special musical experience is the finest one for all of our members, section coaches, and support personnel. It is up to each one of us to always be considerate of others and respectful toward everyone.

To achieve a superior level of commitment, all Honor Group musicians will abide by the following expectations:

1. Be on time with all necessary materials.
2. Be ready to rehearse when rehearsal begins.
3. Behave in a courteous and respectful manner.
4. To be attentive and to refrain from unnecessarily disturbing the rehearsal.
5. No smoking, drinking, or drugs are allowed at any time.

Personal Information

Student Name*

First Name Last Name

Student Phone Number*

Student Email Address*

Parent/Guardian Name*

First Name Last Name

Parent/Guardian Phone Number*

Parent/Guardian Email Address*

School You Attend*

Home Address*

Street Address Address Line 2 City State ZIP Code

Group You Were Selected For*

High School Symphonic Band
High School Orchestra
High School Wind Ensemble

Instrument*

Acceptance Notification*

YES - I am accepting my position within the SCSBOA All-Southern Honor Groups and commit to all rehearsals and concerts.

NOTE: IF YOU ARE DECLINING YOUR POSITION, PLEASE EMAIL MRS. JEANNE CHRISTENSEN IMMEDIATELY.

Optional Photograph Purchase - Doug Gifford Photography

Click for Website
Folder Name: SCSBOA Honor Concert
Password: SCSBOA012818

Activity Permission Slip and Image Likeness Release Form

Please read the statement below and select the appropriate box:

I hereby give permission for my son / daughter to participate in the 2019 SCSBOA Honor Groups. It is my understanding that my student was accepted into this organization based upon results of a live audition. I am aware that the performances amount to an examination of the material covered in rehearsals.

In the event that the activity requires the student to travel, it is agreed that my son or daughter will provide their own transportation to and from the event, and that the SCSBOA will not be responsible for transportation or lodging needs of any student participant. I am also aware that all rehearsals and performances are required. If my son or daughter misses a scheduled rehearsal time, he or she will be refused the right to perform on the SCSBOA Honor Group Concerts.

Finally, I approve the use of my son or daughter's photo likeness to be used for promotional purpose on the internet, and/or in the print and television media.

Permission Slip / Image Likeness Release Response*

YES - I accept the above statement.
NO - I do not accept the above statement.

Parent or Legal Guardian Signature*

Medical Release Form - Authorization to Treat a Minor

I (we) do hereby authorize and consent to any x-ray, examination, anesthetic, or surgical diagnosis rendered under the general or specific supervision of any member of the medical staff and emergency room staff licensed under the provisions of the Medicine Practice Act or a dentist licensed under the provisions of the Dental Practice Act and on the staff of any acute general hospital holding a current license to operate a hospital from the State of California Department of Public Health. It is understood that this authorization is given in advance of any specific diagnosis, treatment, or hospital care being required but is given to provide authority and power to render care which the aforementioned physician, in the exercise of his/her best judgement, may deem advisable. It is understood that the effort shall be made to contact the undersigned prior to rendering treatment to the patient, but that any of the above treatment will not be withheld if the undersigned cannot be reached.

THIS AUTHORIZATION IS GIVEN PURSUANT TO THE PROVISIONS OF SECTION 25.8 OF THE CIVIL CODE OF CALIFORNIA.

Father Phone Number*

Mother Phone Number*

Family Physician*

First Name Last Name

Physician Phone Number*

Physician Address*

Street Address Address Line 2 City State ZIP Code

Medical Insurance Company*

Policy Number*

Student Date of Birth*

Last Tetanus Booster*

Allergies to Drugs or Food

Any Special Medications or Information - List Any Restrictions

Parent or Legal Guardian Signature*

Parent Confirmation

My son / daughter has my permission to participate in the All-Southern California Honor High School Honor Groups. I understand that rehearsals will take place on Friday, January 25, 2019 at the Hyatt Hotel in Garden Grove and Saturday, January 26, 2019 at the Hyatt Hotel in Garden Grove. The concert will be held on Sunday, January 27, 2019 at the Hyatt Hotel in Garden Grove. I understand that every precaution will be taken for the welfare and protection of my child and I hereby release the Southern California School Band and Orchestra Association and the directors and managers of the All-Southern California High School Honor Groups from any personal liability for injuries or illness resulting from the participation of my child in the activity, or from transportation related thereto.

Parent or Legal Guardian Signature*

Student Confirmation

I hereby accept membership in the above selected 2019 All-Southern California High School Honor Groups. I will meet all of the responsibilities and requirements that this membership entails. I understand that all rehearsals and concerts are mandatory. The nonrefundable participation fee is $150, payable from the SCSBOA website with credit card only.

Student Signature*

Secure Payment Information

Non-Refundable Participation Fee

Online Transaction Fee

Price: $0.00

Total Due

$0.00

Secure Payment Information*

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MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Email

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