Registration Form

Student General Information
CHHSid
Student Name*
First Last
Student ID*
Grade 2021-2022 (Starting in FALL 2021)*
Gender*
Student Address*
Street Address City State ZIP Code
Date of Birth*
Date Format: MM slash DD slash YYYY
Student Cell Phone Number
T-Shirt Size*
Instrument*
Select Program Involvement*

Parent/Guardian Information
Parent 1: Information
Parent 1 Name*
First Last
Parent 1 Occupation
Parent 1 Email*
Parent 1 Cell Phone*
Parent 1 Work Phone
Parent 1 Address (if different from Student)
Street Address City State ZIP
Parent 2 Information
Parent 2 Name
First Last
Parent 2 Occupation
Parent 2 Email
Parent 2 Cell Phone
Parent 2 Work Phone
Parent 2 Address (if different from Student)
Street Address City State ZIP

Emergency Information
Medical Contact
Insurance*
Insurance Carrier
Policy Holder's Name
Policy #
Group #
Emergency Contact
Emergency Contact Name*
First Last
Emergency Contact Relationship*
Emergency Contact Phone*

Emergency Information - Continued
Is your student allergic to anything?*
Please Explain Allergies
EpiPen?
- My child carries an EpiPen (or equivalent product) that must stay with them at all times.
Does your student have any dietary restrictions?*
Please explain in detail foods your student cannot eat
Is your student taking any medications regularly?*
List any medications your student is currently taking:
List any medications your student will need to take while at camp/practices (reminder that students are not allowed to have medication on them at anytime. All medications (including Over The Counter medications, must be in the possession of the nurses at all times):
Medications
Please check if any of the below medication may be dispensed to your student
By placing a check in front of the medicine you authorize this medicine to be dispensed to your student.
- Tylenol (acetaminophen)
- Advil / Motrin (ibuprofen)
- Antacid (Rolaids, etc.)
- Benadryl
Explain any other medical conditions or circumstances we should be aware of and how they should be handled if a family member or emergency contact cannot be reached:

2020-2021 MEMBER DUES
Marching Band Member*	Color Guard Member**
1. Marching Registration Fee - $100 (Due by April 30th) 2. May Marching Pmt #2 - $100 ($125 if paid after May 15st) 3. June Marching Pmt #3 - $100 ($125 if paid after June 15th) 4. July Marching Pmt #4 - $125 ($150 if paid after July 15th) 5. August Marching Pmt #5 - $125 ($150 if after after Aug 15th) 6. August Marching Pmt #5 - $125 ($150 if paid after Sep 15th) 7. August Marching Pmt #5 - $125 ($150 if paid after Oct 15th) Marching Band Member Fee - $800	1. Marching Registration Fee - $100 (Due by April 30th) 2. May Marching Pmt #2 - $100 ($125 if paid after May 15st) 3. June Marching Pmt #3 - $100 ($125 if paid after June 15th) 4. July Marching Pmt #4 - $100 ($125 if paid after July 15th) 5. August Marching Pmt #5 - $100 ($125 if after after Aug 15th) 6. August Marching Pmt #5 - $100 ($125 if paid after Sep 15th) 7. August Marching Pmt #5 - $100 ($125 if paid after Oct 15th) Color Guard Member Fee - $700
* Marching Band Member fee includes Concert Curriculum Fee required of all band students	** Guard who also play an instrument will need to additional register for concert band an pay an additional concert fee
REQUIRED FOR ALL NEW MEMBERS (MARCHING/COLOR GUARD) AS INDICATED: MARCHING - Band Shoes - $45 COLOR GUARD - Warm Up Pants/Jacket/Duffle Bag - $115 COLOR GUARD - Colorguard Shoes - $40	OPTIONAL FOR ALL MEMBERS (MARCHING/COLOR GUARD): MARCHING - Band Shoes - $45 Colorguard - MakeUp - $35 (estimated) COLOR GUARD - Personal Practice Rifle - $40 COLOR GUARD - Gloves - $20 COLOR GUARD - Curriculum Fee (if participating in concert band) - $120 Additional Items for Concert Players Concert Band Uniform - $100-$130 (Sept 2020) District Band Auditions $30 (Sept. 2020) All State Jazz Auditions $30 (Sept. 2020) Jazz Band $50 (December 2020) District Band Event Cost $40 (January 2021)
Instrument Rental Fee $30 Per Semester ($60 per year) - If Student Plays School Owned Instrument
Fundraising Obligation (Everyone) - $50 represents the 5 tickets that each member is required to sell/purchase for Taste of Collins Hill @ $10/each in February 2021. This fee is not included in the totals above.

I agree (Must Check Below)*
AGREE: I hereby acknowledge receipt and understanding of the financial obligation policy. All payments are non-refundable. Please understand that if your student decides to quit for any reason, that student is responsible for all payments due up until the date of departure. For example, if your child signs up for marching band and quits before camp starts, they are still responsible for all payments up until we are notified of the departure. Likewise if a student quits in the middle of the season, they are still responsible for all payments due up until the day they quit.

By digitally agreeing, I agree to abide by the policy and meet the financial requirements (amount due & due dates) for participation as outlined in the tables on the this page. I understand that failure to meet the required financial commitments WILL RESULT in my band member being denied participation in any or all parts of the 2020-2021 Marching & Concert Band programs.
- I Agree

Concert Band - Costs

August Concert Band Payment $120 ($145 if paid after August 15th)

Fundraising Obligation** $50 (Due Feb 2021)

Concert Band Member Total $120 (unless you pay after August 15th)

** Fundraising Obligation - $50 represents the 5 tickets that each member is required to sell/purchase for Taste of Collins Hill @ $10/each in February 2021. This fee is included in the totals above, once sold your account will be credited for the tickets sold

OTHER FEES FOR CONCERT BAND (AS REQUIRED)
Concert Band Uniform - $100-$130 (Sept 2020)
Instrument Rental Fee - $30 per semester
District Band Auditions $30 (Sept. 2020)
All State Jazz Auditions $30 (Sept. 2020)
Jazz Band $50 (December 2020)
District Band Event Cost $40 (January 2021)
I agree (Must Check Below)*
I hereby acknowledge receipt of the financial obligation policy. By digitally agreeing, I agree to abide by the policy and meet the financial requirements (amount due & due dates) for participation as outlined in the tables on the first page. I understand that failure to meet the required financial commitments WILL RESULT in my band member being denied participation in any or all parts of the 2020-21 Concert Band Program
- I Agree

Registration Form

CHHS Band Registration 2021-2022

Step 1 of 7

Student General Information

Parent/Guardian Information

Parent 1: Information

Parent 2 Information

Emergency Information

Medical Contact

Emergency Contact

Emergency Information - Continued

Medications

2020-2021 MEMBER DUES

Marching Band Member*

Color Guard Member**

August Concert Band Payment	$120 ($145 if paid after August 15th)
Fundraising Obligation**	$50 (Due Feb 2021)
Concert Band Member Total	$120 (unless you pay after August 15th)