2019-2020
    ​MCCRACKEN COUNTY HIGH SCHOOL
    ​BAND PARTICIPATION FORM 
    ​
    (All Band and Guard Members must complete.)

    PARENTS' INFORMATION
    STUDENTS' INFORMATION
    Medical Consent
    I hereby consent for a qualified physician or surgeon to examine, diagnose, prescribe and perform treatment, inducing surgery that is deemed advisable for the welfare of student #1 as listed above.

    ​I give my permission for this student to take the following over the counter or prescription medications: 
    ​
    NOTE:  Medications will not be given under any circumstance without the prior permission from parent/guardian.  No student is  permitted to have prescription or non-prescription medication on his/her person at any time.
     
    Medical Consent
    I hereby consent for a qualified physician or surgeon to examine, diagnose, prescribe and perform treatment, inducing surgery that is deemed advisable for the welfare of student #1 as listed above.

    ​I give my permission for this student to take the following over the counter or prescription medications: 
    ​
    NOTE:  Medications will not be given under any circumstance without the prior permission from parent/guardian.  No student is  permitted to have prescription or non-prescription medication on his/her person at any time.
     
    Medical Consent
    I hereby consent for a qualified physician or surgeon to examine, diagnose, prescribe and perform treatment, inducing surgery that is deemed advisable for the welfare of student #1 as listed above.

    ​I give my permission for this student to take the following over the counter or prescription medications: 
    ​
    NOTE:  Medications will not be given under any circumstance without the prior permission from parent/guardian.  No student is  permitted to have prescription or non-prescription medication on his/her person at any time.
     
    Medical Consent
    I hereby consent for a qualified physician or surgeon to examine, diagnose, prescribe and perform treatment, inducing surgery that is deemed advisable for the welfare of student #1 as listed above.

    ​I give my permission for this student to take the following over the counter or prescription medications: 
    ​
    NOTE:  Medications will not be given under any circumstance without the prior permission from parent/guardian.  No student is  permitted to have prescription or non-prescription medication on his/her person at any time.
     
    Insurance and Physician Information
    Max file size: 20MB
     If an operative procedure is recommended, I hereby consent to the administration of any anesthetic (general, local of both) by a qualified anesthesiologist.  If a blood transfusion is necessary, I consent to this procedure.  I understand that no one connected with McCracken County High School Band, McCracken County Band Boosters and McCracken County High School assumes liability for any injury incurred by the participant.  I agree to pay all costs incurred by the participant (s) for the hospital bills, physician fees, and ambulance fee.  I understand that I will be contacted by someone in authority at the time my child is admitted to the hospital and/or treated by
    a physician.
McCracken County High School Band ©2018-2019