Sewanhaka District Music Festival
Emergency Information
Student Name______________________________
Member of:
District Band
(circle all that apply)
Home School ___________________________
District Chorus
District Orchestra
Home Phone _________________________ Parent/Guardian Cell Phone _________________________
Allergies/ Medical Conditions:
_______________________________________
Alternate Contact Person
Name ____________________________Relationship ___________________Phone______________
Parent Signature ______________________________________ Date_____________________
Please return this form to your music teacher, along with your Permission Contract by
January 8, 2015.