INDIAN RIDGE MIDDLE SCHOOL MUSIC DEPARTMENT
Information Form
Student's Name: _______________________________________ Date of Birth: _______________
Music Course: ____________________ Period: ____ Instrument or Vocal SATB: ____________
Address: _________________________________ City: ____________________ Zip: _________
Home Phone: ______________________________ E-Mail Address: ________________________
Mother's Name (or guardian): _________________________ Home Phone: __________________
Mother's Place of Work: _____________________________ Work Phone: __________________
Father's Name: ____________________________________ Home Phone: __________________
Father's Place of Work: _____________________________ Work Phone: ___________________
Emergency Contact Name: __________________________ Phone:________________________
Family Doctor: ____________________________________ Phone: ________________________
List Any Known Allergies or Reaction to Medications: ____________________________________
Specific Health Problems or Special Instructions: _______________________________________
List Any Medication the Student Takes Regularly: _______________________________________
Immunizations Received: Yes ___ No ___ Last Tetanus Shot (if ever): _____________________
Does the Student Wear Contact Lenses: Yes ___ No ___
Glasses: Yes ___ No ___
Glasses: Yes ___ No ___Days Available to Volunteer: Mother: _____________________ Father: _____________________
Does anyone play an instrument in your immediate family? Who and what?: ________________
Check Any Areas You Can Help (Music Booster's will contact you as needed):
Trip Chaperone ___Equipment Mover ___Truck Driver ___
Equipment Mover ___Truck Driver ___Fund-raising Planning ___ Concession/Ticket Sales ___ Office Help ___
Concession/Ticket Sales ___ Office Help ___Building Maintenance ___ Assembling New Equipment ___ Telephone Tree ___
Assembling New Equipment ___ Telephone Tree ___Uniform/Shoes ___Instrument Tutor ___ Hospitality ___
Instrument Tutor ___ Hospitality ___Remember, each family is asked to volunteer and log at least one hour each grading period. If your child is in music, then you're in music. Check the monthly MUSIC NEWS for calendar information. Music Booster Meetings are held at 7:00 PM on the first Monday of every month in the Band Room.
Do you have any specific suggestions/talents? __________________________________________
List any specific items/services to donate? _____________________________________________
rev. 8/00
