High School Honor Groups – Payment & Acceptance of Membership

High School Honor Groups - Acceptance 2018 (Deadline: January 3, 2018)

Congratulations on being selected to represent your family, music group, school, and community by being a member of the SCSBOA All-Southern High School Honor Groups!

The responsibility of membership in an Honor Group goes far beyond just excellent musical skills. Your responsibility extends to making every effort to insure 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 Symphony Orchestra
High School Wind Ensemble

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.

T-Shirt Size

As a member of the SCSBOA High School Honor Group, you will receive a T-Shirt commemorating your participation. Please let us know what size ADULT T-Shirt you wear.

T-Shirt Size*

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 2018 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.

Medical Release Form - Authorization to Treat a Minor

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 provision 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 best judgement, may seem 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 Confirmation

My son / daughter has my permission to participate in the All-Southern California High School Honor Groups. I understand that rehearsals will take place on Friday, January 26, 2018 at the Hyatt Regency in Garden Grove and on Saturday, January 27, 2018 at the Hyatt Regency in Garden Grove. There will be a dress rehearsal on Sunday, January 28 at the MUSCO Center for the Arts, Chapman University.

The concert will be held Sunday, January 28, 2018 at Musco Center for the Arts, Chapman University.

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 manager 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 this activity, or from transportation related thereto.

Parent Initials for Confirmation*

Student Confirmation

I hereby accept membership into the SCSBOA All-Southern High School Honor Groups. I will meet all of the responsibilities and requirements that this membership entails. I understand that all rehearsals are mandatory. Confirmation of my $135.00 non-refundable participation fee is due at the SCSBOA Office by January 3, 2018.

Student Initials for Confirmation*

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

Comments

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