2022 Middle School Honor Groups - Acceptance of Participation

Group Membership*

Symphonic Band

String Orchestra

Symphonic Strings

Student's Full Name*

Student First Name Student Last Name

Student Email Address*

An email confirmation will be sent to this address after successfully completing the form.

Parent/Guardian's Full Name*

Parent/Guardian First Name Parent/Guardian Last Name

Parent/Guardian Email Address*

An email confirmation will be sent to this address after successfully completing the form.

School*

School Phone*

Home Address*

Street Address Suite, Apartment, Unit, Etc. City State Zipcode

Home Phone*

Upload Vaccine Card

Students must be fully vaccinated against COVID-19 to participate in the SCSBOA Honor Groups. Students will be asked to upload proof of vaccination upon acceptance. If a parent wishes to apply for an exemption to this requirement, PLEASE CLICK HERE TO COMPLETE THIS FORM. If your exemption is granted, the student will be required to provide a negative COVID PCR test in accordance with the most current CDPH guidelines.

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Acceptance of Membership

Parent/Guardian Acceptance

This student has my permission to participate in the All-Southern California Middle School Honor Groups. I understand that rehearsals will take place on Saturday, March 26, 2022 at Woodbridge High School in Irvine, Sunday, March 27, 2022 at Woodbridge High School in Irvine, and Saturday, April 2, 2022 at Woodbridge High School in Irvine. The concert will take place on Saturday, April 2, 2022 at Woodbridge High School in Irvine. 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 Middle 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.

Student Acceptance

I hereby accept membership in the above selected 2022 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 non-refundable participation fee is $160, payable from the SCSBOA website with credit card only.

Behavior Code for Honor Groups

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 insure that 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:

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

Parent Behavior Agreement

I have read and discussed the All-Southern California Behavior Code for Honor Groups. I understand that should it be necessary for my student to be removed from the Honor Group, I will make arrangements to pick up my student immediately. I will make full restitution for any property damage that my student causes and I will be responsible should any medical or dental treatment be needed as a result of my student’s actions.

Student Behavior Agreement

I agree to follow the above rules of conduct. I further agree that it is my responsibility to conduct myself with pride and to represent my family, my musical group and my school with honor. I understand that if I fail to adhere to this Honor Code, I may jeopardize my future opportunities for participation in honor Groups and that my school director will be notified as well as my school Principal.

Medical Release Form: Authorization to Treat a Minor

I (we) the undersigned parent, parents, or legal guardian(s) of this student, a minor, 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 judgment, 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's Telephone*

Mother's Telephone*

Family Physician*

Family Physician Phone*

Family Physician Address*

Street Address Suite, Apartment, Unit, Etc. City State Zipcode

Medical Insurance Company*

Policy #*

Minor's Date of Birth*

Date of Last Tetanus Booster*

Allergies to Drugs or Foods?*

Yes

Description of Allergies to Drugs or Foods*

Any Special Medications or Information?*

Yes

Description of Special Medications or Information*

Activity Permission Slip & Likeness Release

I hereby give permission for my student to participate in the 2022 SCSBOA Honor Groups. It is my understanding that my child was accepted into this organization based upon results of a audio and/or video audition.

In the event that the activity requires the student to travel, it is agreed that my child 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 aware that all in-person and/or online meetings and/or clinics are required. If my child misses a scheduled in-person or online meeting or clinic, the student will be refused the right to perform on the SCSBOA Honor Groups Concerts.

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

Parent/Guardian Release & Acknowledgement: Signature Required*

Typing your name is the equivalent of a binding physical signature.

Student Release & Acknowledgement: Signature Required*

Typing your name is the equivalent of a binding physical signature.

Secure Payment Form

You must supply a valid email address AND phone number to receive music links and further Middle School Honor Group information. This is the only way you will receive your information and music links! Double check your information before submitting your application.

Email Address for Music & Info Links*

Phone Number for Music & Info Links*

Non-Refundable Participation Fee

Price:

Online Transaction Fee

Price:

Total Non-Refundable Participation Fees Due Today

Billing Address*

Billing Address Same as Home Address Above

Secure Payment Details*

Card Details

Cardholder Name

Comments

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