Livonia Franklin Marching Patriots

31000 Joy Road, Livonia, Michigan 48150 Band Office 734-744-2655 ext. 47862

June 6, 2019

Enclosed in this Marching Band Camp packet are the following items:

1. Camp Information Letter (Camp Rules and Instructions)

2. Band Permission Form 2019-2020 (Blue Sheets)

3. YMCA Risk Waiver, Dietary Restriction form and Health Form

4. Medication Authorization (Livonia Public Schools)-this form should only be submitted if your student takes

prescription medication(s) and must be completed and signed by the attending physician.

5. Livonia Franklin Marching Band Controlled Medication Permission form-this form must be submitted if your

student takes a prescribed Schedule 2 medication (i.e. for ADHD/Pain).

6. Livonia Franklin Marching Patriots Web Policy-Student

7. Media Authorization-Adult

8. Dinkle Shoe Order Form

9. Band Camp Theme Days information

10. Suggested Items for Camp

11. LPS iChat Adult Volunteer/Kroger-Amazon Instruction Sheet

Please read all items carefully. This packet contains information you will need to refer to as Band Camp

approaches. If you need more information about any of these items, please feel free to contact me at

734.233.8099 or monicafulton@sbcglobal.net.

For information or questions regarding any forms, please make sure to visit our website at

www.livoniafranklinbands.weebly.com. There, you can check our calendar for updates. And be sure to provide

us with your email address so you can be added to our list for periodic email updates.

Please return all forms to:

Livonia Franklin Band Boosters ATTN: Corresponding Secretary PO Box 51427

Livonia, MI 48151-1427

Forms can also be dropped in the locked box in the Band Director’s office. All Forms Must Be Returned No Later

Than Friday, July 19, 2019.

As parents, it is important that you help support your child’s extracurricular endeavors. This can be done in

many different ways such as, helping with getting the props on and off the field during competitions, signing up

as a driver, etc. (must have Adult Volunteer forms on file). There are many opportunities to help; find out how at

our monthly Board Meetings the second Monday of every month in the band room at 7:00 PM. Remember, one of

the most important is just to be there cheering in the stands showing all of the kids how proud we are of them

and all of their hard work.

Thank you,

Monica Fulton

Monica Fulton Corresponding Secretary

Franklin Band Boosters

**All families are asked to donate at least one case of water. Water can be dropped off during Pre-Camp week!

Livonia Franklin High School 2019 Marching Band Camp

YMCA Camp Ohiyesa

7300 Hickory Ridge Road, Holly, MI 48442 Phone: 248.887.4533

Monday, August 19 – Saturday, August 24, 2019

Dear Franklin High School Marching Band Members: (Band Members refers to Color Guard and Instrumental Music Members. We are one group!)

This packet contains all the information pertaining to band camp. Please read all information carefully.

1. DEPARTURE TIME: We will leave Monday morning, August 19, 2018 at 8:00 AM from Franklin High School. See Schedule for details. Be at school by 7:00 AM to check in. A parent/guardian MUST sign you in!

2. CABIN ASSIGNMENTS: Your cabin assignments will follow at a later date. Your cabin will be your headquarters for all your personal equipment. Each cabin will be assigned at least one adult counselor. All information and schedules will be relayed from the Director through the cabin counselors to the band members and color guard.

3. BUS ASSIGNMENTS: Your bus assignments will follow at a later date. All band and color guard members are required to ride to band camp on the bus. Return trip will be by private car. This procedure is to save on the cost of hiring return buses. If your parents/guardians do not come to see the show on the last day of camp, you need to arrange to ride home with someone else. We will require a note from home prior to departing for camp regarding who will be driving you home from camp. Please see the Band Booster President if there is a problem. No student will be allowed to leave camp until all equipment is loaded on the equipment truck.

4. MEALS: Camp Ohiyesa will provide Monday lunch through Saturday lunch. Mark your snacks with your name (no peanut products). All snacks and drinks must be eaten in the lodge or outside. Students needing special diets should notify the Band Director, in writing, at least two weeks before band camp to accommodate their needs.

5. ILLNESS OR INJURY: The band will provide a Health Care Professional. The Camp will have an infirmary. Make sure that all prescription bottles are well labeled and identified with your name and checked in before you board the bus for camp. You are not allowed to take any medication on your own, not even Tylenol. All medicine will be given through the camp Health Care Professional.

6. SPORTS EQUIPMENT: The camp will provide the following equipment: volleyball, basketball, soccer and baseball. An in ground pool is also available.

7. CLOTHES AND PERSONAL EQUIPMENT: Please label all items with your name.

8. APPROVED DRESS: Slacks, jeans and shorts may be worn for rehearsals, marching and in the dining hall. Shirts and shoes must be worn in the dining hall. Band Members are required to wear socks at all marching practices. We suggest white sweat socks and tennis shoes. Failure to wear socks causes blisters; blisters are painful and incapacitate you. You cannot learn marching fundamentals and drill design sitting on the sidelines. Please follow these instructions. Wear a shoe that ties on your foot. Loafers, docksides and sandals are not for marching. High top tennis shoes are not recommended, as they are difficult to march in.

9. INSTRUMENT, FOLDING MUSIC STAND, LYRE AND MUSIC: Our musical activities will be devoted to playing and memorizing our marching band show music. You are required to memorize the FRANKLIN FIGHT SONG, STAR SPANGLED BANNER, WARM-UP and the SHOW MUSIC before we go to camp. Make sure you have a proper supply of reeds, oil, etc. before you go to camp. Your instrument must be in perfect condition. The better you know your music, the easier it will be for you at camp. Bring clothespins for your music stand for outside rehearsal.

10. LUGGAGE: Luggage must be kept to a maximum of one piece. NO TRUNKS. Arrange your bedding into a bedroll. A sleeping bag or duffel bag works well. Obviously, your instrument and bedroll do not have to fit in your suitcase. Plan what you need – do not pack any unnecessary items. You have the responsibility for your instrument and luggage. TAG YOUR INSTRUMENT AND LUGGAGE WITH YOUR NAME. PUT YOUR NAME ON ALL OF YOUR THINGS.

11. EVENING ACTIVITIES: All evening activities will be held in the Community Hall or Cafeteria. All band members are required to participate in the evening’s activities unless excused by the Band Director, Health Officer or Counselor.

12. PARENTS: We discourage visitors during the week as this can disrupt and interfere with the focus and concentration of the group. Parents and friends are welcome and encouraged to visit the camp on Saturday, August 24th. Parents must park in the designated parking area. We will take our luggage and bedrolls to this area in the afternoon of August 24th. Parents and family members should meet at the Community Hall or Cafeteria for a brief meeting at 1:30 pm; we will proceed to the field when the students are ready to perform. We will perform our show at 3:00 PM prior to leaving camp. Please do not arrive before 1:00 PM as we are still preparing for the performance. Alumni are welcome at camp for the final performance. Everyone is required to load the truck prior to leaving camp and help unload at school after the camp is over.

13. UNIFORMS: You will be fitted for your during the week prior to Pre-Band Camp (August 14-16, 2019). Exact times to be determined. You will not need to bring your uniform to camp.

14. LEAVING CAMP: We will leave camp by 5:00 PM on Saturday, August 24th. Students are expected to ride home with their parents. NO BAND OR COLOR GUARD MEMBER MAY RIDE HOME WITH ANY OTHER PERSON OR FRIEND UNLESS WRITTEN PERMISSION RELEASING THE BAND DIRECTOR AND LIVONIA PUBLIC SCHOOLS FROM FURTHER RESPONSIBILITY IS PRESENTED TO THE BAND DIRECTOR PRIOR TO DEPARTURE FOR CAMP (form is included in packet). We will need help unloading equipment at school after returning from camp. Please meet at the school to unload.

15. MARCHING BAND SHIRT: Each band member will be issued a band shirt to be worn under their band uniform (again, you will not need your uniform for camp). In case of severe hot weather, the band can perform in a uniform shirt. A pair of Navy Blue Bermuda-length shorts for band members and Black Bermuda-length shorts for color guard will be worn with the band shirt for the final performance on Saturday afternoon at 3:00 PM at camp.

16. BAND PERMISSION FORM: Please fill out all forms and drop in drop box or mail/ drop off to: Livonia Franklin Band Boosters ATTN: Corresponding Secretary PO Box 51427 Livonia, MI 48151-1427 (C) 734.233.8099 (These forms need to be returned no later than Friday, July 26th)

17. SCHOOL REGISTRATION:

All students should have their music for the show before camp. Please learn your music before Pre-Camp. Practice your music regularly. MEMORIZE your part. Be ready to play your part WELL at Pre-Camp. If you have problems understanding your music or playing any of your part, please contact the Band Director or call your section leader. Your section leader will be willing to help you throughout the summer. Make arrangements with them by calling and setting up a time and place to practice.

If you have any questions or problems, please send an email to fhspatriotband710@gmail.com and a Band Booster will get back with you as soon as

possible. You can also call Mrs. Robinet at Franklin High School, 734.744.2655 (or send an e-mail to:srobinet2@livoniapublicschools.org). Or you

can contact Allison Pyle-Potter, President of the Band Boosters, at 734.812.6179, or Monica Fulton, Corresponding Secretary, at 734.233.8099.

HAVE A GOOD SUMMER. KEEP PRACTICING. OUR BAND WILL SOUND AS GOOD AS YOU PRACTICE. LET’S ALL WORK TOWARDS EXCELLENCE. WE HAVE A BIG CHALLENGE THIS YEAR AND I KNOW YOU CAN MEET THIS CHALLENGE. SUCCESS DEPENDS ON THE SECOND LETTER OF THE WORD.

Sincerely, Leann Kuchta Director

MEMORIZE YOUR MUSIC ♫ ♫ ♫ MEMORIZE YOUR MUSIC ♫ ♫ ♫ MEMORIZE YOUR MUSIC

Suggested Items for Camp

Band / Color Guard

(Remember to mark all items with your name!)

Band Stuff

♫ Instrument ♫ Instrument accessories (reeds, valve oil,

slide grease, neck straps, etc.) ♫ Lyre / Flip Folder ♫ Folding Music Stand ♫ Clothes pins ♫ Pencils / SET BOOKS (spiral bound

index cards) ♫ Set markers (i.e., poker chips) ♫ 3-ring binder (1”) to put music in ♫ Small towel to put in music case (in

case of rain) Guard Stuff

♫ Flag / Rifle / Saber ♫ Tape ♫ Guard gloves ♫ Sports bras ♫ Pencils / SET BOOKS (spiral bound

index cards) ♫ Set markers (i.e., poker chips)

Clothing

♫ LOTS OF SOCKS (8+ pair) ♫ Tennis shoes (no marching in flip flops!) ♫ Shower shoes (flip flops) ♫ Sweats (hoodies / pants) ♫ T-shirts ♫ Long sleeve shirts ♫ Black shorts for Saturday (Guard) ♫ Navy Blue shorts for Saturday (Band) ♫ Pants ♫ Shorts (no short shorts!) ♫ Underwear ♫ Raincoat / poncho ♫ Light jacket / sweatshirt ♫ Hat ♫ Sunglasses ♫ Bathing suit

** You will not need your Marching Band uniform for camp**

Bedding / Shower Stuff

♫ Sleeping bag, blankets, sheets, etc. ♫ Pillow ♫ Washcloths ♫ Towels (Bath and Beach) ♫ Shower basket / bucket ♫ Shampoo and Soap ♫ Hairbrush / Comb / Hair Ties ♫ Deodorant ♫ Toothbrush / Toothpaste ♫ Shaving cream / razor (not aerosol!)

Notes:

Miscellaneous Items ♫ Eyeglasses / Contacts ♫ Kleenex ♫ Flashlight ♫ Buddy gifts ♫ Camera (optional) ♫ Knee brace (if needed) ♫ Ace bandages ♫ Prescribed Meds (in original bottle

with Medication Authorization form from doctor)

♫ Bug spray ♫ Sunscreen / Aloe lotion ♫ Boys: Gold Bond powder ♫ Clothes pins (for hanging bathing suits

and towels to dry – optional) ♫ Snacks – No Peanut Products!! ♫ Water bottle / jug (refillable) ♫ Fan

* Over-the-counter medications are provided-please do NOT bring them to camp. ALL OTC

medications (Motrin, Tums, etc.) brought to camp MUST be given to medic at check-in.

YMCA CAMPING SERVICES RISK WAIVER FORMName of Participant Email

Address City State Zip I understand that, as in ail sports/activities there is a risk of physical injury and damage to property and hereby assumesuch a risk and ail consequences thereof, including the risk of personal injuries to the applicant resulting from participatingin any or all of these sports, and agree to be fully responsible for any personal injury or damage to the property arising outof or in connection with the applicant's use of the facilities at the YMCA Premises and/or YMCA Program Locationregardless of the cause, causes or contributing causes of such injury or damage. To this end l/we, as parents and legalguardian(s) of the applicant, a minor, hereby release, discharge, and covenant to hold harmless the YMCA CampingServices, YMCA Camp Ohiyesa, YMCA Camp Nissokone, and any other entity that is the landlord, or sub landlord of thePremises, and/or YMCA Program Location and all of the employees, officers and directors, agents and successors andassigns of the above from any and all claims, causes of action, actions demands, damages, costs, loss and expenses(including reasonable legal fees, which the applicant, or a third party, may have, suffer or incur which in any way arise outof or in connection with applicant's use of the Premises and/or YMCA Program Location regardless of the cause, causes,or contributing causes of such injury or damage. Said release, discharge and covenant shall apply to all such causes ofaction whether arising or prosecuted before or after said minor applicant has reached his or her age of majority.

l/we further promise and covenant (jointly and severally) for myself/ourselves, individually and as legal guardian(s) of theapplicant, and my/our heirs, administrators and executors, not to sue in any name or capacity (or implied in any action)said YMCA Camping Services, YMCA Camp Ohiyesa, YMCA Camp Nissokone, or any other entity that is the landlord orsub landlord of the Premises and/or YMCA Program Location (and/or employees, officers, agents, or successors, assignsof any of the above) for damages or injury to the property or person of the applicant or to myself/ourselves arising out ofor in connection with the applicant's participation in the activities outlined above at the Premises and/or YMCA ProgramLocation regardless of the cause, causes or contributing causes of such an injury or damage.

i/we/am are the parent(s) and legal guardian(s) of the applicant named above. The health history presented to the campis correct to the best of our/my knowledge, and the applicant described on the admissions application has our/mypermission to engage in any or all of the sports/activities at YMCA Camp Ohiyesa and Camp Nissokone, such as:

1. Skateboarding, roller skating, in-line skating, mountain boards and/or similar activities2. Horseback riding3. Climbing on natural rocks and cliffs, the climbing tower, and/or the climbing center, and/or similar activities4. Water sports, including: swimming, kayaking, canoeing, sailing, windsurfing, and rafting, water skiing, wakeboarding, tubing

and/or similar activities5. Paintball, field and target sports6. Tubing (winter)7. And/or similar activities

YMCA Camping Services and Camp Ohiyesa located at 7300 Hickory Ridge Road, Holly, Michigan ("Premises") or Camp Nissokonelocated at 6836 F-41, Oscoda, Michigan ("Premises") or at any other place while involved in the program of the YMCA ("YMCA ProgramLocation").

Authorization for Audio/Visual RecordsI understand that the YMCA may make audio/visual recordings of this camping event. I hereby authorize the YMCA tohave and use photographs, slides, moving pictures, and audio/video tapes of my child (if under 18) and/or myself forpurposes of YMCA records, public relations, and/or advertising.

Release of LiabilityBy signing this form, parent/legal guardian and/or participant acknowledges that they have read and understood the above informationand are signing this form to assure YMCA Camp Ohiyesa/YMCA Camp Nissokone that parent/legal guardian and/or participant assumesall risks during the program. Guardians or participants who do not wish to accept the risks described in this warning should not sign thispermission form.

I hereby give my consent:1. To participate in YMCA Camp Ohiyesa/YMCA Camp Nissokone programs.2. To receive emergency medical care which may become reasonably necessary in the course of such activities or travel.I further agree not to hold YMCA Camp Ohiyesa/YMCA Camp Nissokone or anyone acting in its behalf, responsible for any injuryoccurring to the named participant during YMCA Camp Ohiyesa/YMCA Camp Nissokone programs activities or travel.

DATE Signature of Participant or Parent/Legal Guardian (If participant is under age 18)i have read the aforementioned and will abide by the principles and regulations contained herein.

DATE Signature of Participant

14

SPECIAL DIETARY CONCERNS Participant Name

Please complete this form and return to the teacher/group leader with your child,even if they do not have any special dietary concerns.

Does your student have any Special Dietary Concerns? Yes No

If yes, please describe:

Peanut Allergies? Yes No

If yes, please describe:

Other Food Allergies? Yes No

If yes, please describe:

Teacher/Group Leader School/Group

Parent/Guardian Contact Phone

Note to group leaders: Dietary forms should be grouped and/or summarized then faxed at248-887-5203 or mailed to Camping Sen/ices office a minimum of 2 weeks prior to camp.

15

HEALTH FORMNote: YMCA Camping Services does NOT carry health/accident insurance for group participants. (In order to participate incamp programs, this form must be signed and must be presented to your group's leader upon your arrival at camp.)

Participant's Full Name Address City State Zip

_ Home Phone (_Participant's Age_

1Birth Date

Name of Parent/Guardian or Spouse Home Phone ( ) Work Phone (_Home Address

Cell Phone

If parents/spouse are not avaiiable in an emergency, please notify:Name Relationship Home Phone (__Home Address

1 Work Phone Cell Phone (_

Family Physician Name of Insurance Subscribe^Name of Insurance Provider

Medicaid ID #

Physician's Phone (_

Policy/HMO #Medicare # BC/BS Contract #

Does your child/the participant have any problems with the following?Yes No Yes No

Asthma [Sleep Walking [Allergies to Food [Hearing Loss [Kidney problems [Bee Allergies [If yes, please explain:

Yes NoSeizuresHigh Blood PressureAllergies to MedicationsBone/Joint ProblemsRespiratory ProblemsInsect Allergies

Heart ProblemsLow Blood PressureDiabetesBedwetiingFear of Heights

Is there any reason your child should not sleep on an upper bunk? (All upper bunks have railings)

Does your child/participant have any other serious medical problems/been under a physician's care recently?[ ]Yes [ ]No If yes, please explain:

Does your child/participant have any dietary restrictions?

List activities limited or prohibited by a physician

Date of last Tetanus shot: Is your child/participant currently on medication? [ ] Yes [ ] NoIf yes, please explain: Can Tylenol be administered to your child if necessary? [ ] Yes [ ] No

Parent's/Participant's AuthorizationAM of the above information is correct to the best of my knowledge and the person herein describedhas permission to engage in all camp activities except as noted. I hereby give permission to order X-rays, routine tests, treatment, and necessary transportation for my child or me. In the event I cannotbe reached in an emergency, I hereby give permission to the physician selected to secure andadminister treatment, including hospitalization, for my child/myself as named above.

Signature Date Adult participant (or parent/guardian if participant is under 18)

Note: This form should be collected by the group leader and kept by your group's Health Officer.

16

Livonia Franklin Marching Patriots Web Policy

2019 – 2020 Marching Band Season

Dear Parent(s) or Legal Guardian(s):

From time-to-time, as the Livonia Franklin Marching Patriots broadcasts or publishes information regarding

its programs or activities, your student may appear in photographs, video or audio recordings, or other

media, for public display. Your student will only be identified by first name in any of the photos that have a

recognizable image.

Before engaging in such publication or broadcast, we are seeking your general consent to permit the use of

your student’s photograph as part of a group picture and music ensemble. We are also seeking separate

and specific consent to display photographs of your student that may contain a recognizable likeness and

may be identified by the student’s first name. When the publication is on the Internet, identification will be

by first name only. Please complete the below authorization and return it with your band permission form.

Also attached is the adult authorization form that we are asking booster members to sign so that pictures of

audience participation may be displayed on our website as well as members of the board may be identified

to the booster membership.

STUDENT AUTHORIZATION

We/I ________________________________________________ as the parent(s) or legal guardian(s) of (Print Name)

_________________________________________ (“the student”) hereby authorize and permit the public (Print Student’s Name)

and private use, broadcast, publication, reproduction, release, copyright, exhibition and distribution of the

student’s image and or recording(s), either audio or video as part of the entire marching band as a group

and would not be identified by name. Additionally, unless noted below we/I hereby authorize and permit the

public and private use, broadcast, publication reproduction, release, copyright, exhibition of the student’s

image and/or recording(s), either audio or video that may be recognizable and may be identified by the

student’s first name only. We will authorize such disclosure for purposes of providing information regarding

the Livonia Franklin Marching Patriots programs or activities.

o We/I do NOT authorize the publication of images and identification on the Livonia Franklin Marching

Patriots website that specifically identify my student.

_____________________________________________________________________________________ Signature of Parent/Guardian Print Name Date

_____________________________________________________________________________________ Signature of Student Print Name Date

Livonia Franklin Marching Patriots

Dinkle Marching Shoes

All Marching Band Members must have Dinkle Marching Shoes as a part of their uniform; each band member

will need to purchase their own to keep. We do have a stock of donated used shoes that are available on a first

come/first served basis. We have limited sizes but you can see if there is a size that fits you, they will be

available to try one during uniform fittings. Otherwise we will place a group order, which saves money on

shipping. We must have your order and payment on Wednesday, August 14th during pre-band camp week.

The order will be placed during camp and the shoes will be available for pick up at post-camp rehearsal.

Cost: $30 (includes tax and shipping)

Sizes Available: (*available in wide width)

Women’s Sizes – 5.5, 6, 6.5, 7, 7.5, 8*, 8.5*, 9*, 9.5*, 10*, 10.5*, 11*, 11.5, 12

Men’s Sizes – 3.5, 4, 4.5, 5, 5.5, 6, 6.5*, 7*, 7.5*, 8*, 8.5*, 9*, 9.5*, 10*, 10.5*, 11*, 11.5*, 12*, 13*, 14*, 15, 16

If your student will be wearing thick socks for cold weather you may want to order a 1/2 size larger.

What are Dinkles?

The most affordable shoe on the market today providing the safety and stability of a full rubber sole.

• Special Rubber blended (TPR) sole for superior traction and long wear. • Forepart Pad & Flex Zone gives extra flex and cushioning under the ball • Runner's Ortho Cup contours to the foot to soften every step. • Man-made Uppers for long lasting, great appearance with a low

maintenance and no polish finish that will last. • Light Weight Construction & High Density Foam insole for comfort.

Uniform Fittings: Uniform fitting for your student will take place during mandatory pre-camp week (August 14th-16th). Shoe order forms with full payment will be turned in on Wednesday, August 14th.

Dinkle Order FormStudent Name: Grade:

Size: Men’s Wide Women’s Wide

Contact Information:

Phone:

Email:

$30 due at the time of order. Please make checks payable to: Livonia Franklin Band Boosters.

31000 Joy Road, Livonia, Michigan 48150 Band Office 734-744-2655 ext. 47862

of the foot.

Band Camp Theme Days and Buddy Gifts

Band Camp is the week of August 19-24, 2019. It is one of the hardest, as well as the most fun, weeks of Marching Band. Every day is a different theme, listed below. Students are encouraged to participate and everyday there will be a tally for each class. At the end of the week, the class with the most spirit points will receive a prize. It is not required to go ‘all out’ for the theme days; a simple t-shirt that applies to the theme will count. Keep in mind the students have to march in it so the outfit must be comfortable and light since it will be hot. At band camp, every day the students are also requested to give a Buddy Gift to their Secret Buddy, which will be drawn before band camp. Every student will fill out a survey of what their interests are and that will help you determine what your buddy might like. Most students buy their buddy gifts at a dollar store. Examples of buddy’s gifts are; candy (NOT CHOCOLATE), balls, water guns, and other little fun toys. As a reminder – pack extra socks, bug spray, and sunscreen since you will need more than you think for Band Camp. Band Camp Theme Days Monday: Tacky Tourist Day Tuesday: Favorite Sports Team Day Wednesday: Pink Out Day Thursday: Section Color Day

Flutes – Light Blue Clarinets-Purple Saxophones-Burgundy Low Brass-Pink Trumpets-Navy Blue Drum Line-Black Color Guard-Red Pit-Yellow Friday: Class Color Day Freshman-Pink Sophomores-Purple Juniors-Navy Blue Seniors-Tie Dye Saturday: Show Shirt Day See your section leader if you have any questions.

FRANKLIN HIGH SCHOOL BAND PERMISSION FORM 2019 – 2020 (RULE 117 (2), 127 (1,2))

PART 1 – STUDENT AND EMERGENCY CONTACT INFORMATION (PLEASE PRINT)

STUDENT’S NAME: ______________________________________ BIRTHDATE: __________________ GRADE: _______

STUDENT’S E-MAIL ADDRESS: ______________________________________ STUDENT T-SHIRT SIZE: _________________

ADDRESS: ____________________________________________ CITY: _________________ ZIP CODE: _____________

FATHER’S NAME: _________________________________ E-MAIL ADDRESS: ___________________________________

FATHER’S ADDRESS: ___________________________________ CITY: _________________ ZIP CODE: _____________

HOME PHONE: ___________________________________ CELL PHONE: __________________________________

MOTHER’S NAME: ________________________________ E-MAIL ADDRESS: ___________________________________

MOTHER’S ADDRESS: _________________________________ CITY: ___________________ ZIP CODE: _____________

HOME PHONE: ___________________________________ CELL PHONE: __________________________________

HEALTH INSURANCE CARRIER: ______________________________________ POLICY #: _________________________

PRIMARY PHYSICIAN: ______________________________________________ PHONE: ___________________________

IN CASE OF EMERGENCY (if parents or guardian cannot be reached) CALL:

NAME: ________________________________________________ RELATIONSHIP: _______________________________

PHONE: ______________________________________________________________________________________________

PART II – PERMISSION TO PARTICIPATE (Please notify the Band Director if any of this information changes during the school year.)

In granting permission, I understand that although band participation is a school sponsored activity, and although there will be a

teacher and parent chaperones present, and although they represent the Livonia School District, that neither the teacher, parents nor the

School District are liable in case of an accident or injury that occurs during band trips.

In case of medical emergency, I understand that every effort will be made to contact the parents or guardians of the participant.

In the event that I cannot be reached, I hereby give permission to the physician selected by the sponsor to hospitalize, secure proper

treatment for, and to order injection, anesthesia, or surgery for my child as named above. I also give permission for the trip nurse to

administer first aid and to dispense any medication listed below.

I further understand that my son/daughter will be expected to follow all the rules set forth for all band trips. I also promise that my

son/daughter will not use any alcoholic beverages or drugs at anytime when they are with the Marching Band.

Should _________________________ fail to comply with these rules, I will come immediately when I am called and return (Student’s Name)

him/her to my home, or I will arrange for that to happen. In agreement with the above, I, therefore, allow my son/daughter to participate in all Marching Band trips and performances.

SIGNATURE: __________________________________________________________ DATE: ________________________ (Parent or Guardian)

I promise not to use any alcoholic beverages, tobacco or drugs at anytime that I am with the Marching Band. SIGNATURE: __________________________________________________________ DATE: ________________________ (Student)

PART III – TRAVEL PERMIT

__________________________________ has my permission to travel by bus with the Marching Band for the 2018-2019 school year. (Student’s Name)

I understand that my child is expected to follow the rules and regulations of student conduct on the bus that are based upon state safety regulations and are outlined in the Franklin High School Parent and Student Handbook and the Franklin High School Marching Band handbook. Although all due precaution will be taken to avoid accidents, it is agreed that in such a case, the school and/or teacher will not be held responsible.

I also understand and agree that under no circumstance will my child be permitted to drive themselves to or from a Marching Band competition. We want to assure that every child arrives safely to all competitions.

My child is allowed to ride with a Livonia Public School approved parent/chaperone should buses not be utilized. Students must provide a written note by noon the day of a competition/performance to the Band Director if they will not be riding with their assigned car pool chaperone.

SIGNATURE: __________________________________________________________ DATE: __________________________ (Parent or Guardian)

PART IV – MEDICAL INFORMATION

Does your child have ALLERGIES? YES: ____________ NO: ____________ If yes, list them, including FOOD ALLERGIES:

_______________________________________________________________________________________________________

Is your child allergic to bee stings? YES: _____ NO: ____ Does your child wear CONTACT LENSES? YES: ____ NO: ____

Are there any limitations of physical activity? YES: __________ NO: __________ If yes, please explain:

_______________________________________________________________________________________________________

Does your child have any emotional or behavior problems that we should be aware of? If yes, please fill out Confidential Form (Rule 127e) attached.

Does your child have any special health or medical conditions? YES: __________ NO: __________ If yes, please be specific:

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

Are your child’s IMMUNIZATIONS current? YES: ________ NO: ________ (You must check either yes or no.)

Date of last TETANUS shot: ______________ (Please know that should your child receive an injury that warrants a tetanus shot and no date is listed, your child will receive a tetanus shot.)

Will your child need to take any MEDICATION while at camp? YES: __________ NO: ___________

If yes, please attach a note from the parent/guardian; (1) giving permission to administer the medication, (2) whether the medication is prescription or over-the-counter, and (3) what the medication is being taken for. If the medication is prescription, the prescribing doctor must fill out and sign the Livonia Public Schools Medication Authorization form (attached) and give specific instructions regarding how and when the medication should be administered. MEDICATION(S):

________________________________________________________________________________________________________

________________________________________________________________________________________________________

Please make sure all medication is clearly labeled with the student’s name and directions. Prescription medication must be in the original bottle. ALL MEDICATION MUST BE TURNED IN at the beginning of the trip (including Tylenol). Asthmatic inhalers may stay in the student’s possession at all times. All other medication will be returned at the end of the trip. Please make sure to pick medication up from the camp Health Care Professional before leaving camp on Saturday, August 24th.

I hereby give my consent for the nurse, Director or Health Care Professional to administer any of the following medication to my child as necessary to include, but not limited to: TYLENOL, ACTIFED, PEPTO-BISMOL, CALADRYL, ADVIL, BENADRYL, etc.

SIGNATURE: ________________________________________________________ DATE: ____________________________ (Parent or Guardian)

CONFIDENTIAL FORM (Rule 127e)

STUDENT NAME: ______________________________________________________________________________________

Does your band or color guard member have any infectious diseases? YES: __________ NO: __________

If yes, please explain. This information will be kept confidential by the Band Director and Health Care Professional.

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Does your band or color guard member have any emotional or behavioral problems? YES: _______ NO: ______

If yes, please explain. This information will be kept confidential by the Band Director and Health Care Professional.

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(**This form is confidential in such that only the Band Director, Band Booster President, Corresponding Secretary and Health Care Professional will have access to it.**)

PERMISSION TO RIDE HOME FROM BAND CAMP WITH SOMEONE OTHER THAN PARENT OR GUARDIAN

I give permission for my son/daughter __________________________________________________ to ride home from Band Camp (Name of Student)

with __________________________________________________________________. (Name of Adult Driver)

___________________________________________________________________ DATE: _____________________________ (Signature of Parent/Guardian)

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EMERGENCY RELEASE FORM

Please list to whom your child may be released in case of an emergency, if you are unavailable.

NAME RELATIONSHIP PHONE NUMBER

1. ________________________________________________________________________________________________________

2. ________________________________________________________________________________________________________

Livonia Franklin Marching Band

Controlled Medication Permission Form

(Only complete if student is taking Schedule II medications i.e., for ADHD/Pain)

Student Name: _______________________________________________________________

Name of Medication: __________________________________________________________

Reason for Medication: ________________________________________________________

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Prescribed Dosage: ___________________________________________________________

Time of Administration of Medication: _____________________________________________

Possible Side Effects / Reactions to Medication: _____________________________________

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All medication must be in the original container with patient’s name,

prescribing physician’s name and directions for use.

Prescribing Physician

Physician Name: _____________________________________________________________

Phone: _____________________________________________________________________

Street Address: ______________________________________________________________

City: ___________________________________ ST: ___________ Zip: _______________

Parental Permission to Administer Medication

I hereby authorize the administering of my child’s medication by an authorized chaperone, band

director, or instructor exactly as per the directions prescribed by the above named physician.

Parent/Guardian Name: ________________________________________________________

Street Address: ______________________________________________________________

City: ___________________________________ ST: __________ Zip: ________________

Phone: ______________________________ Cell: _________________________________

Signature: ________________________________________ Date: ____________________

Record of Administration must be kept on the reverse side of this form.

Record of Administration

Date Time

Signature of Person Administering Medication