BAND

HANDBOOK
2019-2020

Preston Thomas

 Liberty High School
Band Handbook

Staff
Preston Thomas – Director of Bands
440-560-8115
prestonthomas@bandiscool.com
Alfie Leyton – Assistant Director of Bands
440-843-5307
alfieleyton@bandiscool.com
Othmar Kaj Vesley – Color Guard instructor
440-245-4190
othmarkajvesley@bandiscool.com
Zoe Murgatroyd – Drumline Instructor
440-537-1327
zoemurgatroyd@bandiscool.com
Website – bandband.org

Table of Contents
Staff .................................................................................................................................. 2
Mission Statement ............................................................................................................ 4
Goals ................................................................................................................................ 4
Types of Bands .................................................................................................................. 4
Private Lessons ................................................................................................................. 6
Attendance Policy ............................................................................................................. 7
Grading Policy ................................................................................................................... 7
Rehearsal Expectations ..................................................................................................... 8
Marching Band Performance Expectations ........................................................................ 9
Concert Etiquette .............................................................................................................. 9
Code of Conduct .............................................................................................................. 10
Marching Band Uniform ................................................................................................... 10
Concert Band Attire ......................................................................................................... 12
Equipment ....................................................................................................................... 13
Purchase Equipment at School ......................................................................................... 13
Leadership ....................................................................................................................... 13
Band Boosters ................................................................................................................. 14
Awards ............................................................................................................................ 14
Fundraisers ...................................................................................................................... 16
Calendar .......................................................................................................................... 16
Personal Information Questionnaire ................................................................................ 18
Instrument Agreement Rental Form ................................................................................ 19
Medical Release Form ...................................................................................................... 19
Field Trip Permission Slip ................................................................................................. 22
Signature Page ................................................................................................................. 23
References ....................................................................................................................... 24


Mission Statement
We, the _____ High School Band, pledge ourselves to the highest standards of
excellence. We dedicate to trust each other and carry ourselves with pride. We
strive to improve our musical and visual performance and to work hard always.
With honor, integrity, and discipline we further ourselves as individual people and
as a band family.

Goals
Each student will increase his/her performance proficiency on his/her
instrument or implement, and will increase his/her proficiency in the marching
arts.
Each student will grow in his/her level of personal responsibility and self-
motivation.
Each student will expand his/her artistic awareness, in appreciation of their
own growth as musical and physical artists, and in appreciation of other
individuals’ and other bands’ performances.
The ensemble will have several meaningful, quality performances during the
year, as well as several successful competitions. Success, incidentally, does not
necessarily mean winning. It means performing our very best at every rehearsal
and performance, both individually and as an ensemble. We need to “leave
everything on the field” every time!
Each student will have fun improving themselves and becoming part of the
band!

Types of Bands
Concert Bands – The foundation of our program
Concert Band: This group is a concert band that meets Block 7. The
Concert Band performs at school concerts most likely combined with
members of the Symphonic Band. Members of Concert Band are eligible to
participate in the Basketball Pep Band, Musical Pit Orchestra, and
Solo/Small Ensemble Festival.

 Symphonic Band: Students in grades 9-12 selected for this band through
the audition process in October will perform at all school concerts, the Chili
Supper in February, and the State Large Group Festival in April.

Wind Ensemble: This band is made up of a selected group of students.
Personnel for this group will be determined by audition in October. All band
students in grades 9-12 who were in the marching band are eligible for this
ensemble. This ensemble performs at all school concerts, the Chili Supper
in February, the SMSD Band Festival and State Large Group Festival in April.

Athletic Bands – The most visible of our Bands
Marching Band, Grades (9 by audition) 10-12: This group performs at
football games, parades and marching festivals/contests. It is the most
visible music group in the school and brings a great deal of pride to the
music department, school and community. It does require some rehearsals
outside of school time as well as some weekend performances. After
football season the band will divide into the Symphonic Band or Wind
Ensemble.

Pep Band
The Pep Bands are open to anyone grades 9-12 who would like to
participate. During football season we may meet at some away games to
play music, make some noise and support our team. During basketball
season, the Pep Bands play for several boys and girls home games. The
rehearsal and performance schedules will be posted as the season nears in
the end of October.

Jazz Bands – Our uniquely American musical art form
Top Jazz: This is the school’s top performing jazz band. This band is made
up of students selected the previous spring from an audition process.
Enrollment is limited. Top Jazz performs at numerous community and
school functions throughout the year.

Jazz Lab: This band has an open enrollment policy for students who play
jazz instruments (within the director’s discretion). Students in grades 9-12
may participate. Extensive study of jazz history, improvisation, and
understanding jazz styles is the focus of this course.


Other Ensembles – Pit Orchestra, Full Orchestra, Percussion Ensemble...
Percussion Ensemble: This group is mandatory for all 9-12 grade marching
percussion students during marching season. They meet on Monday or
Tuesday evenings from 6:00p.m. until 9:00p.m. After marching season, the
rehearsals will be from 6:00p.m.-8:00p.m. The group will then work on
various world drumming techniques, novelty percussion and standard
percussion ensembles. Later in the year they will produce a full-length
concert and perform in venues throughout the community.

More information on these and other groups will be posted as the
opportunities arise. Membership will vary but numerous opportunities exist
to perform if you have the desire.

Private Lessons
A private lesson is an opportunity for your student to work one-on-one with a
highly-qualified and experienced performer and teacher who specializes in their
particular instrument.

Who teaches private lessons?
The private lesson staff at ____ is made up of university-level performers or
higher. Our teachers range from degreed teachers and performers to
undergraduate performance and education majors. All lesson staff has been
interviewed to ensure appropriate teaching techniques and concepts. All ____
private lesson teachers have applied with and been approved by ____. They have
all been subjected to fingerprinting and an FBI criminal background check.

Who needs private lessons?
We strongly recommend that all students wanting to improve on their instrument
take private lessons. Students playing school-owned instruments are highly
encouraged to participate in lessons. Because of difficulty of those instruments,
lessons are a requirement for students playing oboe and bassoon. Private lessons
are not tutorials. If you can afford private lessons you should take them. Nothing
will improve your playing faster than private lessons.

How often are the lessons, and how much do they cost?
Private lessons are usually 30 minutes long, once a week. Because the private
lesson teachers are not employees of ____, the lesson cost may vary between
teachers and instruments. Generally, the cost is around $20 per 30 minute lesson.

If I start private lessons, can I stop if necessary, or do I have to do it for the
entire year?
Private lessons are not required, only recommended. We ask that all private
lesson students remain in lessons for the duration of the school year, but we
understand that financial difficulties occur. If your financial situation doesn’t allow
you to continue with lessons, we ask that you let your lesson teacher and your
band director know at least two weeks before stopping lessons. That way we can
try to help the lesson teacher fill the hole in their schedule. For many of our
lesson teachers, private lessons make up a large part of their income. Stopping
lessons without notice makes it very difficult for us to keep qualified teachers.

Attendance Policy
All students must be at the assigned location, in your seat, or in the parade
block, with all equipment and music to be considered ‘on time’ for a rehearsal or
performance. Students that are late will lose their daily rehearsal points and be
subject to the _____ High School tardy policy. During marching season, students
will run a lap around the rehearsal field for being tardy. Set those alarms! When a
student reaches 3 tardies, they will receive a 30-minute detention in the band
room. Students will be able to “redeem” their tardies with band service as
determined by the directors. After the second detention from the band, the
student will be referred to the office for additional consequences.

Grading Policy
Each quarter’s grades will be comprised of three components explained below.
There is no weighting per category. The number of points per assignment gives
significance to each category. Therefore, extra credit may serve as make-up
points for any category.
 Daily work: 15 points per day will be awarded according to participation.
Points are awarded based on productivity and readiness to learn. Daily points will
also be given for occasional written assignments.
Singing and Written Tests: Tests will be given each quarter based on music
prepared in class as well as sight-singing exercises.
Performances: Due to the importance of performances, each performance is
worth 200 points. Absences will only be excused for personal illness with prior
notification from a doctor or parent, or a death in the family. Points are awarded
for punctuality, appropriate dress, proper performance technique, and proper
concert etiquette.

Rehearsal Expectations
Students are expected to be in the Band Room when the bell rings. Tardies will
be strictly enforced, and are subject to _____ attendance policies in the Student
Code of Conduct. Note that excessive tardies from a class at the high school level
may result in eventual removal from the course!
Students are expected to be seated and ready to rehearse within TWO
MINUTES of the bell. Students failing to meet this expectation will be marked as
tardy for that day.
No food (including gum) or beverages of any sort may be present or consumed
during music rehearsals.
All students must bring these required materials to their seat for every
rehearsal
• Instruments and necessary accessories such as reeds, mouthpiece, etc.
• Special attachments called for in the music (such as mutes)
• Pencil
• Folder with all current sheet music
Talking while a conductor is on the podium is interpreted as a total lack of
respect for your classmates and instructors. Please focus on the task at hand
during the rehearsal time.
Ensembles will be given two minutes to pack up equipment at the end of class.
In classes where chairs and stands are to be stacked, three or four minutes may
be allowed. Students are to remain in the Band Room until the bell rings (unless
the instructor gives special permission to leave). Students caught leaving the
classroom prior to the bell ringing without the director’s permission will be
assigned a detention; this is your warning!

Marching Band Performance Expectations

At competitions members will sit together in the bleachers with adult
chaperones and must check in/out with chaperones for concession/restroom
breaks.
At competitions when a group of students has checked out with an approved
chaperone they must be in transit or in line, not loitering.
At competitions members will be polite to all other bands, applauding
appropriately and saving polite discussion for after performances.
At football games members are to refrain from having food/drink in the
bleachers.
At football games members are expected to return from break and be back in
the bleachers with the band with 2 minutes remaining in the third quarter.
At football games and competitions members are expected to be attentive to
what is taking place on the field.
At football games members are expected to follow the drum major’s directions
and be ready to perform on cue.
At performance venues members must walk in groups of three or more when
not seated with band.

Concert Etiquette
FOR THE PERFORMER
Be well groomed, bathed, and properly dressed. Avoid perfumes and cologne.
Warm up independently before arriving, be punctual to warm up with the group.
Be mentally prepared and make sure there is nothing in your mouth, including
gum. 

Upon arrival, enter in a calm relaxed state, focused on the upcoming
performance. 

Enter and exit the stage with poise, dignity, and confidence. 

When waiting to perform, exude exemplary audience etiquette. 

Enjoy the performance! 

FOR THE AUDIENCE
Arrive early enough to find a seat before the concert begins. 

Silence all electronic devices. 

Once the concert begins, stay seated. If you must leave or enter the theatre, do so
between songs. 

Please do not talk and keep young children quiet as well. If a child is disturbing
others, please take them to the lobby. When the child is calm, re-enter between
selections. 

Show appreciation with proper applause. In a formal concert setting, whistling,
yelling, and calling people’s names are unacceptable. 


Code of Conduct
Attendance at all rehearsals and meetings regarding the trip is mandatory.
Each student will demonstrate mature behavior by being considerate of
others, using good judgment, and always acting in cooperation with other
students, adult chaperones, and staff personnel.
Each student will be required to attend all the scheduled performances. Each
student will also attend all functions designated as a group activity unless excused
by the director. The adult chaperones will also attend all such performances and
activities.
Each student will always be on time for all performances and other scheduled
activities
Each student will follow all bed check/lights out times.
Each student will wear the prescribed uniform dress at all performances.
No student shall purchase, possess, or consume alcoholic beverages during
any portion of the trip.
No student shall purchase, possess, or consume tobacco products or illegal
drugs of any kind during any portion of the trip.
Any student not adhering to the Code of Conduct will be sent home as soon as
possible at the parents’ / guardians’ expense.

Marching Band Uniform

Uniforms are issued during the marching camp in August. A complete uniform
consists of: band jacket, black pants, cape, garment bag, and shako (hat). Black
shoes and black gloves for ALL marchers will be purchased during camp. Cost for
shoes is $30.00 and gloves will be $5.00. Students will be responsible to pay for
both black shoes and gloves prior to the first performance, in addition to the
regular band fees. BLACK OVER-THE-CALF SOCKS are required to be worn with
the uniform. For the first home football game, you may need black shorts to wear
with your socks, shoes and band T-shirt.

You have been assigned a uniform that has your name on a label and is kept on
the rack by sections behind your section leader’s uniform (It should always be
there and stored there.) It will be yours for the season. You won’t be taking it
home, but you are responsible for it in these ways:
1. Every time you wear your uniform, you need to wear soft nylon or cotton-
like shorts (NO jeans or any other heavy or rough fabric), your band t-shirt,
and your required black socks and shoes. Don’t forget your black gloves.
You will all be changing together in the band room or in a parking lot in
front of everyone. It will be easier if you could just wear the shorts, t-shirt,
black socks and shoes to school, since you will ride the bus in uniform.
2. Always make sure your uniform has your neck band and snap it in place.
When you return from any event you will be taking it out and giving it to
your section leader.
3. All hair needs to be in the hat, both male and female, so please bring
whatever you need to pin it, or tie it up.
4. Please be careful to keep your uniform clean by watching where you sit and
not eating with your jacket on.
5. If you have a repair of ANY kind (dirt or stain, lost buttons or snaps, etc…)
please fill out a repair tag and hang your uniform as usual with the repair
tag over the hanger on the outside of the bag and HUNG IN THE
DESIGNATED LOCATION. It will be repaired and you will find it again on the
rack with your section behind your section leader. If something needs to be
fixed while at an event, we always bring a sewing kit.
6. After an event, please hang your uniform correctly on the hanger so it
doesn’t wrinkle.
7. If by some slim chance you forget to wear your black socks or bring your
black gloves, it will cost you $5.00 to purchase them for that performance.
If you forget your T-shirt, you will be charged $10. Invoices will be sent at
the end of the season for anyone who has purchased extra gloves, shoes or
T-shirts.
8. Uniform Moms will be around at every event. Please ask for assistance.
The band room is busy, and we all want things to go smoothly so you can
 get to where you need to be feeling relaxed and able to have a fun time
with your friends.

Concert Band Attire

Black formal dress: Tux coats for men will be provided. They are property of
____ and will be kept in the uniform room. They are hung in numerical order with
your name in a window of the bag. They must be placed back in order on the tux
coat rack when the concert is completed. The following items are the student’s
responsibility to purchase.
o Men – Black dress pants, tux coat, dress shoes and socks, white tux
shirt with black bow tie and black cummerbund. Tux shirts and bow
tie sets can be purchased for between $40-$60 from J.C. Penney’s,
Dillard’s or any formal wear shop.
o Women – All black: Long black dress or long black skirt with a black
top, or black dress pants with a black top. Dress shoes also to be
warn. This is to be FORMAL dress, revealing clothing, casual pants
and flip-flops are not acceptable.

Ladies in all bands: It is our goal to achieve a conservative, uniform and formal
appearance for our concerts. The audience attention should be drawn to our
ensembles, not to individuals. In this spirit, please avoid strapless tops, straps and
low neck lines. If the dress has straps, a sweater or shrug must be worn. The
dress should have sleeves. All skirts and dresses should be mid-calf or longer (2”-
4” from the floor at most – see picture). When you sit in a chair, the dress should
cover your knees. No flip-flops.

The last concert of the year is traditionally in “nice, springy” clothes. No
tuxedos, no formal concert black. Jeans, t-shirts, and tennis shoes are
unacceptable for concert dress. If you show up dressed improperly, you will not
perform, or you will be asked to go home and change into the correct dress. If
you do not perform, you will receive a “0” grade for that performance. At NO
TIME will hair of an un-natural color be allowed.

Equipment
In order to maintain a safe and clean band environment, all members of the
_____ Band Program are responsible for the general care and maintenance of our
equipment and facilities.
1. At the conclusion of each performance and rehearsal, students must return
instrument to the case, and place it in the assigned location.
2. Only members of the percussion section should handle or play the
percussion equipment, unless given permission from the Band Director(s).
3. Students using a school-owned instrument will complete the Instrument
Sign-Out Form (distributed at the beginning of the season). Repairs on a school-
owned instrument may be the financial responsibility of the student, as
determined by the Band Director(s).

Purchase Equipment at School

Should you need extra items because yours broke or is non-functional, we
keep reeds, valve oil, tuning slide grease, and SD1 Generals in stock for you to
purchase.
Reeds (clarinet and sax) - $3 each
Reeds (oboe and bassoon) - $15 each
Valve oil - $2
Tuning slide grease - $2
SD1 Generals - $10

Leadership
1. Each season, two Drum Majors will assist the Band Director(s) in running
rehearsals and performances. Students aspiring to one of these positions audition
at the end of the previous school year.
2. Within each instrument section of the marching band, the Band Director(s)
appoint a student as Section Leader. In the case of larger sections, more than one
Section Leader may be appointed. Section Leaders are responsible for calling and
running sectionals during the season.
Drum Major
 A Drum Major is a band member who has chosen to take an advanced
leadership position in the program. Drum Major selection is through audition and
demonstration of conducting abilities, verbal commands, and a leadership
interview. Drum Major auditions take place late in the preceding school year.
The duties of a Drum Major include but are not limited to conducting during
rehearsals and performances and assisting with administrative tasks associated
with running the band. He or she is also responsible for assisting band members in
learning music, drill, and marching fundamentals. In addition, a drum major is to
supervise the loading/unloading of equipment and uniform inspection.
Section Leader
Section Leaders are outstanding musicians and leaders, appointed by the Band
Director(s) who demonstrates a high level of achievement and enthusiasm. They
are responsible for assisting band members in learning music, drill, and marching
fundamentals. In addition, Section Leaders will assist with attendance and music
checks. These individuals are essential to the band’s success and must
demonstrate proper attitude during rehearsals and performances.

Band Boosters
_____ Band~Aides is the official parent support organization for the _____
bands. This is an incredible group of parent volunteers that provide chaperones,
support, and financial aid to our program. EVERY parent is strongly encouraged
to become an active member in _____. Membership is $10.00 per year, per
family. Come and join in the fun!! _____ will sponsor the annual Fall Picnic in
August, the Spaghetti Dinner & Auction in October, the Chili Supper in February,
and our Band Awards Banquet in May. _____ also offers scholarships to band
camps in the summer as well as scholarships for major trips IF the parents are
active members of LBA. As with any great organization, _____ is only as good as
the people involved. YOU are always needed and appreciated. _____ Band Aides
will meet the first Tuesday of each month, at 7:00 P.M. in the band room, unless
otherwise noted.

Awards
Participation Awards for Band Students
Freshman - Lyre Pin and Service Bar
Sophomores - Service Bar
Juniors - Service Bar
Seniors - Service Bar

Seniors and Drum Majors
The Senior Color Guard members are given a Crossed Flag Pin.
Seniors in Marching Band are given a plaque in appreciation of their effort in
Marching Band
The Drum Majors receive a Drum Major Pin.

Band Letters
Band Letters are awarded once a student has earned 6 points. Points are
earned by type of Band Class that the student has completed. In the year the
student earns the Band Letter, they do not receive a service bar.
Mr. Norman awards several certificates in different categories each year and the
following four National Awards.

The National School Marching Award
The National School Marching Award® recognizes outstanding
contributions on the field. It honors the musical contributions and dedication of
student leaders whose example inspires others. The student will receive a
plaque.

The Louis Armstrong Award
This award was inaugurated in 1974 with the consent of his widow shortly
after this great artist died in 1971. It honors the outstanding jazz musician at each
High School. The student receives a desk sized trophy.

The Patrick S. Gilmore Award
This award was introduced in 1994 in honor of the legendary bandmaster
and impresario. Patrick Gilmore(1829-1892) and his band joined General
Burnside's expedition to North Carolina in the Civil War. Gilmore also played for
every president of his day, including Abraham Lincoln. This beautiful award
honors outstanding high school band students and their achievements and
commitment to the band. The student will receive a plaque.

The John Philip Sousa Award
 This award was introduced in 1955 to honor the top student in the high
school band. The award recognizes superior musicianship and outstanding
dedication. It was created with the approval of Helen Sousa Albert and Priscilla
Sousa, daughters of the famous composer and bandmaster. The student receives
a desk sized trophy.

Fundraisers
The Music Department will participate in product-selling fundraisers a few
times per year and an art show in January. Other events such as concessions,
dances, etc. may also occur and will need parent volunteers to help raise money
for the band. Profit earned from the fundraisers may be applied to band fees and
earmarked for trips.

Calendar
09 Aug 2019 Kirkwood School District Opening Day, Keating Theater
16 Aug 2019 Fall Pep Rally, Gym
30 Aug 2019 Home Football Game vs. Francis Howell
14 Sep 2019 Home Football Game vs. Rockwood Summit
15 Sep 2019 Greentree Parade
28 Sep 2019 Home Football Game vs. Ritenour
05 Oct 2019 Home Football Game vs. Eureka
19 Oct 2019 Home Football Game vs. Ladue
26 Oct 2019 District Football Playoffs TBA
02 Nov 2019 District Football Playoffs Probable Home Game TBA
09 Nov 2019 District Football Playoffs TBA
16 Nov 2019 District Football Championship TBA
23 Nov 2019 State Football 6A Championship at Missouri State TBA
20 Nov 2019 Pep Assembly (during school)
21 Nov 2019 Turkey Day Pep Rally & Bonfire
04 Dec 2019 BANDEMONIUM!, Keating Theater
04 Dec 2019 Marching Band Awards Cafeteria
19 Feb 2020 Festival of Bands (WE, JB)
28 Feb 2020 Band Concert (WE, SB, CB, WWCE, BC)
07 Mar 2020 Large Ensemble Music Festival at KHS (WE, SB, CB)
09 Mar 2020 District Solo & Small Ensemble Music Festival, Parkway Central
25 Apr 2020 Night of Percussion; (WE, SB, CB PERCUSSION SECTIONS)
27 Apr 2020 State Solo and Small Ensemble Music Festival, Columbia, MO
01 May 2020 Band Concert (WE, SB, CB) 7:00PM
09 May 2020 Jazz Band and Jazz Combo Concert
11 May 2020 Graduation; CHAIFETZ ARENA (CONCERT BAND ONLY)
Personal Information Questionnaire

Name________________________________________________ Date___________________
My birthday is________________________________________________________________

My family members are

_____________________________________________________________________________

After graduation, I plan to_________________________________________________________

______________________________________________________________________________

My greatest asset is______________________________________________________________

______________________________________________________________________________

I am an expert on________________________________________________________________
______________________________________________________________________________

One thing people don't know about me is_____________________________________________

______________________________________________________________________________

My teachers last year will tell you that I am___________________________________________

______________________________________________________________________________

I have trouble dealing with________________________________________________________

______________________________________________________________________________

My favorite class is ________________________________________because_______________

______________________________________________________________________________

The most influential person in my life is __________________________________because_____

______________________________________________________________________________

It was difficult for me to learn_____________________________________________________

______________________________________________________________________________

It was easy for me to learn________________________________________________________

______________________________________________________________________________

I want to know more about________________________________________________________

______________________________________________________________________________

Three words that describe my personality are_________________________________________

______________________________________________________________________________

One lesson I had to learn the hard way is_____________________________________________

______________________________________________________________________________
Instrument Agreement Rental Form

Grade ____ Homeroom / Classroom (teacher name & room #)_____________________________

Student Name (print)______________________________ ID#______________

INSTRUMENT: ___________________________ SIZE ____________

MAKE:______________________________ SERIAL #_____________

ESTIMATED VALUE $__________CONDITION: NEW GOOD FAIR POOR

NOTES:
We agree to be responsible for the school instrument listed above. It is our responsibility to maintain the
current condition of the instrument and case listed above. We understand that repair due to natural “wear
and tear” of the instrument will be handled by _____. We also understand that any damage or loss caused
by misuse, abuse, or negligence on the part of the student will be the responsibility of the student and / or
parent / guardian.

There is a $40.00, non-refundable rental fee for the academic school year for each instrument rented. The
summer rental fee is $20.00. Make checks payable to _____. Please put the fee and contract form in an
envelope marked with student name(s) and room number. Each child needs his/her own contract. Please
write checks separately for either the String Dept. or the Band Dept. Instruments may not leave school
until contract and deposit are received. If paying the entire fee at once may be too imposing, contact your
student’s instrumental teacher and a payment plan may be set up on an individual basis.

Student Signature_____________________________________

Parent Signature______________________________________

Parent/Guardian #1`Contact Information

Name Address

Phone Email

Parent/Guardian #2`Contact Information (if different)

Name Address

Phone Email

Medical Release Form

Over-The-Counter Medication

By initialing below, I give permission for school personnel to administer the

following medication(s) as needed to my student for minor discomfort or injury.
Medications supplied by school may vary between buildings and grade levels.

_____ Acetaminophen (Tylenol)
_____ Ibuprofen (Advil or Motrin)
_____ Cough

drop (non-medicated)
_____ Topical medication (antibiotic ointment, calamine
lotion, hydrocortisone cream) _____ Antacid

_____ Eye drop (non-medicated lubricating)
_____ Antihistamine oral

(diphenhydramine, cetirizine) _____ Antihistamine allergy eye drops

Parents may also supply other over-the-counter medications. Please list below:

Medication name: ________________________ Dosage: ___________

Reason given: ___________________________ Time: _____________

Medication name: ________________________ Dosage: ___________

Reason given: ___________________________ Time: _____________

Prescription Medication

Medication name: ________________________ Dosage: ___________

Reason given: ___________________________ Time: _____________

Medication name: ________________________ Dosage: ___________

Reason given: ___________________________ Time: _____________

On early dismissal or late start days please indicate one of the following:

____Do NOT administer medication on early dismissal days

____Administer medication at adjusted lunch time

____Do NOT administer medication on late start days

____Administer medication at prescribed time

To ensure continuity of care, I give permission for the school nurse to

communicate with my student’s healthcare provider regarding medication
administration at school.

Healthcare provider name: Phone number:

School personnel who administer medication according to proper dosing

instructions shall be held harmless for any adverse reaction experienced by the
student. My student has previously taken the medications(s) listed above with no
known adverse reaction.

Parent/guardian printed name:
Parent/guardian signature: Date

Revised 4/9/2015

Field Trip Permission Slip

Permission Slip – Overnight Trip Field Trip Permission and

Waiver Form (With Chaperones)
Students have many opportunities to participate in various extra class activities as an outgrowth
of classroom interests or through special interest clubs. On occasion it will be to their advantage
to attend activities away from the school campus (Field trips). However, the School Board and
_____ cannot assume responsibility for the safety and welfare of students while engaged in a
field trip beyond making reasonable provision for activity chaperones.

I understand that my child must abide by all _____ rules, regulations and chaperone instructions
on the field trip indicated below. I understand that School chaperones cannot prevent injuries
because they cannot always control the conditions present or be present at all times.

Your signature below constitutes and is evidence of your agreement to (1) accept general liability
for the participation of your child in the field trip identified below and (2) indemnify and hold
harmless the _____, its _____, its employees and agents, either jointly or severally, from and
against any and all claims, damages, causes of action or injuries, including reasonable attorneys’
fees and costs expended in defense thereof, incurred or resulting from your child’s participation
in this trip including transportation.

1. School _________________________ Class/Activity ___________________________

2. Faculty Sponsor __________________________________________________________
3. _________________________ has my permission to take part in a field trip to

________________________________________________________________________
I understand that this is an excused absence and any work missed for this trip is to be
made up in accordance with each school’s student handbook. I also understand this is an
overnight trip and my child has been instructed to abide by school rules and policies for
the duration of this trip.

4. Travel arrangements: I understand my child will travel by _________________________

leaving approximately _____________ and returning at approximately ______________.

Parent or Guardian Signature ______________________________________

Date __________________________

Phone: Work ___________________________ Home ___________________________

Cell _____________________________
Signature Page

By signing my name below, I certify that I have read the above information. Any
questions concerning these policies have been discussed. My signature also
certifies my understanding of and agreement with the above policies. A
photocopy of this document is as valid as the original. You may receive a copy of
this document upon request



. _______________________________________ ____________________
Student Signature Date


. _______________________________________ ____________________
Parent Signature Date

References

Shawnee Mission West Band Handbook – from my Dad


Sumner Academy Choir Handbook – from my Mom


Manvel Junior High Handbook - https://www.alvinisd.net/Page/28548


Charles A. Beard Memorial School Corporation -
https://www.cabeard.k12.in.us/site/handlers/filedownload.ashx?moduleinstance
id=238&dataid=1661&FileName=Field%20Trip%20Permission-Overnight.pdf


Folwell School, Performing Arts Magnet Music Department -
http://folwell.mpls.k12.mn.us/uploads/rental_contract_eng.pdf


New Teacher Academy Handbook -
https://web.archive.org/web/20100621055642/http://www.misd.net/Newteache
racademy/NewTeacherAcademyHandbook.pdf


Kirkwood Band Handbook - https://www.kirkwoodschools.org/Page/5675