Marching Band Registration Form

Is the member under 18 years of age?(Required)

Yes

Member Information

*Youth member info to be filled out by parent or guardian

First Name(Required)

Last Name(Required)

Date of Birth(Required)

Phone Number(Required)

Email(Required)

Contact Information

Street Address(Required)

City(Required)

Province(Required)

Postal Code(Required)

Parent/Guardian Contact Information

Parent/Guardian #1 Name(Required)

Parent/Guardian #1 Phone(Required)

Parent/Guardian #1 Email Address(Required)

Parent/Guardian #2 Name

Parent/Guardian #2 Phone

Parent/Guardian #2 Email Address

Medical Information

Alberta Health Care Number(Required)

Do you have any allergies or medical conditions?(Required)

Yes

Please describe any allergies or medical conditions.(Required)

Emergency Contact

First Name(Required)

Last Name(Required)

Phone Number(Required)

Email Address(Required)

Music History

What instrument do you play?(Required)

How Many Years Playing(Required)

Medical Consent

I do hereby express my intent to travel with the Grande Prairie Marching Band. Should I become "unable to communicate and require medical attention" while on tour, I specifically authorize any member of the Marching Band Executive who may be present to consent on my behalf to such medical treatment (including but restricted to the generality of the foregoing, inoculation, blood transfusion or surgery) which in the opinion of a qualifie medical practitioner may be necessary.

Medical Consent(Required)

Yes

Liability Consent

It is expressly understood and agreed that I am participating with the Grande Prairie Music society entirely at my own risk and that neither Myself nor my executors, assignees, heirs or representatives will hold the Grande Prairie Music Society, its Executive, their agents or other band members responsible for any death, injury, loss or damage occasioned to my person or property during the course of rehearsal, performance, and associated activities, however same may be caused whether with or without negligence on the part of any person and whether such occurs during band planned activities or during free time. I hereby acknowledge and agree that the Grande Prairie Music Society and its Executive, do not assume any responsibility for loss of wages, or the cost of medical, dental or hospital care incurred by band members participating.

I agree to the above terms & conditions(Required)

Yes

Photo Consent

Throughout the season, photos may be taken of the band and its individual members. Some of these photos may be used for advertising and promotional purposes including the GP Music Society's website and Facebook page. Pictures of the whole band in full uniform will be posted without signed permission; there will be no names posted with photos. Close-ups, individual or candid shots, will not be posted without your permission. Please let us know your wishes regarding photos of you.

Photo Consent(Required)

Yes, I allow individual photos to be posted.

No, I do not allow individual photos to be posted.

Fundraising

The Grande Prairie Music Society is a non-profit society, because of this we must fundraise. To keep the annual membership fee at $10/ family for the Marching Band, we require members to volunteer for a minimum of 2 fundraising events each year.

I agree to participate in a minimum of 2 fundraisers each year.(Required)

I agree

CAPTCHA