Services — VHS Band Boosters

STUDENT EMAIL

Authorization to Render Emergency Medical, Dental, Surgical or Hospital Care to a Minor

Dear Parent or Guardian, This is the Emergency Medical Information Form for members of the band and color guard at Vista High School. It is to everyone’s advantage that you will make a complete and frank statement regarding your child’s health. Please include anything that will require special attention as well as a list of medications (including aspirin), or foods, to which he/she may be allergic to and should not be given. This information will be kept in strict confidence.

OTHER

II. Specify allergy to drugs (i.e. Penicillin, Insulin, etc.) or foods:

III. Is the student currently taking any medications? (Include anti-convulsive, antihistamine, insulin, and tranquilizers)

IV. Thoroughly discuss here and with the Band Director prior to each event, the medication, the dosage and the condition for which it is prescribed:

Statement of Authorization

The undersigned parent or legal guardian of [THE STUDENT NAMED ABOVE], a minor, hereby authorizes the Band Director and/or designated adult, to consent to any emergency medical or dental treatment to be rendered to said minor under the supervision and upon the advice of a physician, surgeon, or dentist licensed under the provisions of the California State Medical/Dental Practice Act. This authorization shall remain effective until July 1, 2021or sooner if revoked by the undersigned in writing, or by the Band Director or any Administrator of Vista High School, Vista, California.

Vista High School Band and Pageantry Corps Activity Permission Slip and Image Likeness Release

Vista High School Band Booster

2024-2025 Contact Information Form

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