March 30, 2018

Middle School Band Camp – Sign up here!

Johnston County Middle School Band Camp Application

Applicant Name:*
Parent Name:*
Address:*
E-mail:*
Contact Phone:*
-
Instrument:*
Middle School:*
T-Shirt Size:*
Grade:*
6th Grade ONLY:
Medical Release
Parent/Guardian Name:*
Childs Name:*
Emergency Phone:*
-
Special Medical Concerns/Conditions:*
Medical Insurance Company:*
Insurance Policy Number:*
Physician Name:*
Physician Phone:*
-
As parent and legal guardian I authorize the staff of this event to seek, obtain and consent to treatment for my child listed on this form as deemed necessary by a licensed medical or healthcare professional. This authorization covers the entire time my child is a student at the band camp.*
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