2022-2023 HHS Music Class Registration

Date form submitted

MonthDayYear
2022-2023 Homestead HS Instrumental Music Class Forms
Welcome to the 2022-2023 school year!

Now that the school year has gotten started, it's time for all students participating in a band class, orchestra, or jazz to complete the paperwork that's required for off campus events and performances. These are the forms that must be completed for all students:
- FUHSD Parent-Guardian Field Trip Permission and Medical Authorization (Minor)
- FUHSD Athletic-Activity Participation Authorization and Emergency Form
- FUHSD Parent-Student Agreement Form
- HHS Instrumental Music Behavior Expectations and Attire Guidelines
- Acknowledgement of Important Dates
- HHS Music Department Photo, Video & Interview Release Form
After you complete the forms, you will have a chance to learn about the Homestead High School Music Boosters. The Boosters is a parent-run 501(c)(3) non-profit who's sole purpose is to support all of Homestead's Music programs. Your Boosters membership and tax-deductible donations provide vital funding to the music programs, including Band Classes, Jazz, and Orchestra. Your contributions offset expenses not covered by the school, such as additional instructional staff, new instruments, equipment, and repairs. Please consider a tax-deductible gift to support the music programs. Corporate matches are especially appreciated!

Please be sure to submit your forms no later than Friday, September 30th.

Questions? Email the Band Admin Team at admin@homesteadband.org.

Thanks!

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

A few notes about the registration form:
- This webform is hosted by JotForm.
  - If you would like to complete hard copies of these forms instead of using the webform to complete and submit the forms, please contact the Admin Team at admin@homesteadband.org.
- The data entered into this webform will automatically populate a PDF of the paper registration forms (including signatures).
  - Please note that the electronic signatures collected via this webform are considered binding.
  - If you do not want to submit signatures electronically, please contact the Admin Team at admin@homesteadband.org to make alternate arrangements.
- Before you submit the form, you can
  - Save your progress and continue later.
  - Preview the populated PDF and make changes.
After the form is submitted:
- The populated PDF and its corresponding data will be forwarded automatically to the Homestead HS Band Admin Team.
- You will have the option to download and/or email a copy of the populated PDF for your records.

Contact Information

Student
Student name on school records*

Student First NameStudent Last Name
Student Nickname
Name student uses that's different from what's on school records
What is the student's gender?*
What are the student's preferred pronouns?*

He/Him/HisShe/Her/HersThey/TheirsOther
Student's home address - Street*
Student's home address - City*
Student's home address - Zip Code*
Student's home phone number*
Grade in the 2022-2023 school year?*
Student's Homestead HS ID number*
Student's Homestead HS email address*
This email should end in @student.fuhsd.org.
Which instrumental music classes will your student be in during the 2022-2023 school year? Choose all that apply.*

Concert Band, Symphonic Band, Wind Ensemble 2, or Wind Ensemble 1Orchestra/Chamber OrchestraJazz Ensemble

Parent/Guardian
Parent/Guardian 1 - Name*

First NameLast Name
Parent/Guardian 1 - Primary phone number*
Parent/Guardian 1 - Secondary phone number
Parent/Guardian 1 - Email address*
What language is primarily spoken at home?*
Parent/Guardian 2 - Name

First NameLast Name
Parent/Guardian 2 - Primary phone number
Parent/Guardian 2 - Secondary phone number
Parent/Guardian 2 - Email address

Emergency Contact
Emergency Contact - Name (other than a parent)*

First NameLast Name
Emergency Contact - Relationship to student
Emergency Contact - Primary phone number*

Student Health/Medical Information
This section of the form asks questions about the student's health information as it pertains to what a FUHSD staff member should know when your student is away on a field trip that doesn't last overnight. Student health information that would only apply if the student was going to be on an overnight trip is not necessary to provide.

The questions about health insurance are asked only because the FUHSD forms ask for it.

If you have any questions about the questions asked in this section, please contact Jen Schaub, Band Admin, at admin@homesteadband.org.
Does the student have any special health needs or conditions that staff should be aware of when the student goes away for a field trip?*

No. The student does not have any special health needs or conditions that staff should be aware of.Yes. The student has special health needs or conditions - including food or medication allergies - that staff should be aware of.
What is the student's special health need? Please be as specific and detailed as possible. Please also include any food or medication allergies the student has.*
Does the student take or carry any medication for a special health need or condition that a staff member would need to be aware of while away on a field trip?*

No, the student does not take any medication that a staff member should be aware of.Yes, the student does take or carry medication that a staff member should be aware of.
What medication(s) is the student currently taking or carrying? Please be as specific as possible about the names of the medication(s), the amounts/doses, and the timing of the amounts/doses.*
Is the student covered by medical or health insurance?*

YesNoUnsure
What is the name of the student's health/medical insurance carrier?*
If the student does not have insurance, type "none".
What is the policy number for the student's insurance coverage?*
If the student does not have insurance, type "none".
What is the group number for the student's insurance coverage?
What is the mailing address for the student's insurance carrier

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Field Trip Permission and Medical Authorization (Minor)

Fremont Union High School District
{StudentName} has my permission to go on the following voluntary field trip:

Destination: All Music Department Activities

Date(s): 2022-2023 School Year

Departure time: varies

Return time: varies

Person in charge: John Burn, Ben Scharf, Daniel Piazza, Kyle Wong, Jen Schaub, Shawn Gongwer
Does your student have any health needs that staff should be aware of and will the student need to take medication on the trip?*

My student has NO special health needs the staff should be aware of, and NO medication is required on the trip.Yes, my student has a special health need and medication will be required on the trip.
The student's special health need(s): {SpecialHealthNeeds_Details}

Medications student is currently taking or carrying: {Medications_Details}

In the event of illness or injury, I do hereby consent to whatever x-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment and hospital care are considered necessary in the best judgment of the attending physician, surgeon, or dentist and performed by or under the supervision of a member of the medical staff of the hospital or facility furnishing medical or dental services.

As stated in California Education Code Section 35330, I understand that I hold the Fremont Union High School District, its officers, agents and employees, harmless from any and all liability or claims, which may arise out of, or occur, in connection with my student's participation in this activity.

I also understand and am fully aware that there may be periods of time during this activity in which my student has free time and is unsupervised, and that the District assumes no responsibility for the student's activities or behavior during this free time. I fully understand that participants are to abide by all rules and regulations governing conduct during the trip. Any violation of these rules and regulations may result in that individual being sent home at his/her and/or parents' expense and possible suspension or expulsion from school. It is further understood that the above-named student may travel by automobiles operated by District employees, adult volunteers, or other licensed drivers, including students.

As parents/guardians of the above named student, it is realized that field trips have certain risks involved and that reasonable attempts will be made to safeguard students and equipment, but that no amount of precaution taken by the instructors can ensure this safety if the student does not obey and cooperate and is unable to accept the responsibility for his/her own actions.
Parent Signature - Field Trip Permission*

Clear
Date signed - Parent - Field Trip Permission*

MonthDayYear
Date
Student Signature - Field Trip Permission*

Clear
Date signed - Student - Field Trip Permission*

MonthDayYear
Date

Athletic/Activity Participation Authorization & Emergency Form

Fremont Union High School District

School: HHS

School Year: 2022 - 2023

Student name: {StudentName}

Student Gender: {Gender}

Grade: {Grade}

Home Phone: {StudentHome_Phone}

Parents'/Guardians' names: {PG1_name}, {PG2_Name}

Home address: {HomeAddress_Street}, {HomeAddress_City} {HomeAddress_ZipCode}

Parent/Guardian 1 Phone: {PG1_Phone1}, {PG1_Phone2}

Parent/Guardian 1 Email: {PG1_email}

Parent/Guardian 2 Phone:{PG2_Phone1}, {PG2_Phone2}

Parent/Guardian 2 Email: {PG2_Email}

Name of other Emergency Contact: {EmergencyContact_Name}

Emergency Contact Phone: {EmergencyContact_Phone1}

Special Medical Conditions: {SpecialHealthNeeds_Details}

INFORMED CONSENT & SPORTS INJURY RISK WARNING STATEMENT

By its very nature, competitive athletics can put students in situations in which serious, catastrophic, and perhaps fatal accidents could occur. By granting permission to your son/daughter to participate in athletic competition, a parent/guardian acknowledges that playing or practicing in any sport can be a dangerous activity involving MANY RISKS OF INJURY. Both the athlete and parent must understand that the dangers and risks of playing or practicing include but are not limited to: death, complete or partial paralysis, brain damage, serious injury to virtually all internal organs, bones, joints, ligaments, muscles, tendons, and other aspects of the skeletal system and potential impairment to other aspects of the body, general health and well-being. However, it is impossible to totally eliminate such incidents from occurring.

Because of the dangers of participating in sports, players may reduce the chance of injury by following coaches' instructions regarding playing techniques, training, equipment and other team rules, etc., both in competition and practice and agree to obey such instructions. Damaged equipment must be reported immediately. Even if all these requirements are met and even if the athlete is using excellent protective equipment, we understand that a serious, maybe even a fatal accident may occur.

INSURANCE REQUIREMENTS (Parents must also complete this section)

California law (Ed. Code Section 32221) requires every member of any interscholastic athletic team, as well as those associated directly with any interscholastic team, athletic event, including song and cheerleaders, team mascots, team manager, etc. to possess accidental bodily insurance providing at least $1,500 of scheduled medical and hospital benefits. Please check the box below if you have the required insurance coverage for your son or daughter.
We have insurance coverage for our family which provides at least $1,500 medical and $1,500 hospital benefits with the following Medical Insurance Company. Our policy also covers high school contact sports.*

Yes, we have the required insurance coverage.No, we do not have the required insurance coverage.I do not know if we have the required insurance coverage.
Name of Medical Insurance Company: {HealthInsurance_Name}

Policy #: {HealthInsurance_PolicyNo}

Group #: {HealthInsurance_GroupNo}
UNDERSTANDING/AGREEMENT, CONSENT TO TREAT, & WAIVER/RELEASE OF LIABILITY

We the under-signed, have read and understand the Informed Consent and Risk Warning Statement above and we have met the insurance requirements as described above. We also certify that our child has received the required Physical Examination by a licensed medical doctor, has been cleared to participate in school sports and activities for the upcoming school year, and the completed Physical Forms have been submitted to the appropriate high school officials. In signing below, we grant our son/daughter permission to participate in extracurricular school sports/activities, to be released from school when required, and to travel to and/or ride as a passenger in a vehicle driven by another parent or coach to school-sponsored events. Lastly, we hereby authorize the coaches and other personnel of the Fremont Union High School District to act for me/us according to their best judgment in any emergency requiring medical attention for my/our son or daughter, and we hereby waive, release, and hold harmless, the Fremont Union High School District, its Officers, Agents, Employees, and Board Members from any and all liability while traveling to and from, and/or participating in school-sponsored activities.
Parent Signature - Athletic/Activity Form*

Clear
Date signed - Parent - Athletic/Activity Form*

MonthDayYear
Date
Student signature - Athletic/Activity Form*

Clear
Date signed - Student - Athletic/Activity Form*

MonthDayYear
Date

Parent/Student Agreement Form

Fremont Union High School District
Please review the Fremont Union High School District's Extracurricular and Co-Curricular Activities Guidelines and Code of Conduct/Steroid Policy.
We have read and understand the Fremont Union High School District's Guidelines for Participation in Extracurricular and/or Co-Curricular Activities, as well as the District's Code of Conduct and Policies regarding Steroids and other performance enhancing supplements and agree to follow these guidelines.

Student's High School Sport(s) and/or Activities Trying out for: All Music Departrment Activities

Student Name: {StudentName}

Student ID#: {ID_Number}
Student Signature - Parent/Student Agreement*

Clear
Date signed - Student - Parent/Student Agreement*

MonthDayYear
Date
Parent/Guardian Name(s): {PG1_name}, {PG2_Name}
Parent/Guardian Signature - Parent/Student Agreement*

Clear
Date signed - Parent/Guardian - Parent/Student Agreement*

MonthDayYear
Date

BEHAVIOR EXPECTATIONS AND ATTIRE GUIDELINES

HOMESTEAD HIGH SCHOOL INSTRUMENTAL MUSIC
Please review the Homestead High School Instrumental Music Department - Behavior Expectations and Attire Guidelines.
Student Name: {StudentName}
Student Signature - Behavior/Attire*

Clear
Date signed - Student - Behavior/Attire*

MonthDayYear
Date
Parent/Guardian Name: {PG1_name}
Parent/Guardian signature - Behavior/Attire*

Clear
Date signed - Parent/Guardian - Behavior/Attire*

MonthDayYear
Date

Acknowledgement of Important Dates
Parents/Guardians - Please review the Important dates for Band Classes with your student.
Parents/Guardians - Please review the important dates for the Orchestra with your student.
Parents/Guardians - Please review the important dates for the Jazz Ensemble with your student.
Please indicate your agreement*

I have read the important dates information listed above a acknowlege that my student will attend the events listed above.
Please indicate your agreement*

If for any reason, my student is unable to attend any of the events above, I will contact John Burn, Director of Bands and Orchestra, (john_burn@fuhsd.org) or Ben Scharf, Associate Director of Bands, (ben_scharf@fuhsd.org) as soon as possible to let them know.
Parent/Guardian Signature - Band Important Dates*

Clear
Date signed - Parent/Guardian - Band Important Dates*

MonthDayYear
Date

Photo, Video & Interview Release Form
The Homestead High School Music Department asks for the unqualified right to allow pictures and/or video to be taken for use in Homestead High School District Music Department Performance Video publications and Homestead High School Music Department social media accounts. The photographs and/or video are not to be used in any other commercial venture without the authorization from the Homestead High School Music Department or said parent or guardian.
I give the unqualified right.I do NOT give the unqualified right.
Student Name: {studentName73}

Grade: {whatGrade}
Signature - Parent/Guardian - Image Release*

Clear
Date signed - Parent/Guardian - Image Release

MonthDayYear
Date

Music Boosters
Dear Homestead Music Families-

Did you know that the Homestead High School Instrumental Music Department has over 275 students enrolled in one (or more!) of our 6 classes or our 3 after school activities. Did you also know that over the years, Homestead's instrumental music ensembles have earned Unanimous Superior awards at CMEA Festivals and have traveled across the United States to perform in noted venues such as Carnegie Hall in New York City and The Kennedy Center in Washington, DC?

The skill levels of these students range from complete beginners to being selected for an All-State Ensemble. You can learn more about Homestead's instrumental music ensembles at www.homesteadband.org/programs.

The Music Boosters is a parent-run, non-profit volunteer organization with the sole mission to encourage, promote, and support the activities of our school's outstanding music programs for the benefit of all music students.

Some of the ways that students in music classes benefit from Music Boosters support are:
- Loan instruments for student use
- In-class instruction by guest clinicians and coaches
- Organizing parent volunteers who
  - chaperone students at off-campus events and performances
  - ensure that on-campus performances run smoothly
  - help manage and maintain our instrument inventory
Without the Music Boosters, the Homestead Music Department would not be able to provide the opportunies for musical growth and accomplishment that it does. And without the time, talent, and financial contributions from families, there cannot be a Music Boosters organization. We invite you become a member of the Homestead High School Music Boosters, and consider making a tax-deductible donation in addition to your membership. We also ask that you consider volunteering your time and talent to the Boosters.

Go Mustangs!

José Liste, Boosters President (president@homesteadband.org)
Judy Cooks, Boosters Vice President (vp@homesteadband.org)
- Questions about volunteering? Email volunteer@homesteadband.org.
- Questions about financial support? Email treasurer@homesteadband.org

Music Boosters Membership
Your Music Boosters Membership is important to the operation of the organization. The money collected for Music Boosters Membership allows us to conduct business as a non-profit. It also covers the operating costs to run as a booster organization. All families with a student in HHS Music are encouraged to become a member.

The membership levels are:
- $75 - Basic Family Membership
- $375 - Gold Level
- $500 - Platinum Level
Please indicate your desired level of membership. Your contribution ensures that we maintain our non-profit status. *
Membership amounts above $75 are considered donations and are tax-deductible to the extent allowed by law.
Tax deductible membership amount

Tax Deductible Donation to Music Boosters
Your donations to Music Boosters provide vital funding to the music programs, including Band Classes, Jazz, and Orchestra. Your contributions offset expenses not covered by the school, such as additional instructional staff, new instruments, equipment, and repairs. Please consider a tax-deductible gift to support the music programs. Corporate matches are especially appreciated!

Donations to the HHS Music Boosters are tax-deductible to the extent allowed by law.
Donation to Music Boosters*

$100$200 (recommended)$300Other amount
Boosters Donation - Tax Deductible

Financial Assistance Fund
Homestead High School is proud of its music programs where all students can succeed, regardless of financial status. If your family is able, please consider donating to the Financial Assistance Fund. The recommended donation amount is $50, but any amount is appreciated.

Donations to the HHS Music Boosters are tax-deductible to the extent allowed by law.
Donation the Financial Assistance Fund*

$25$50 (recommended)$75Other amount
Financial Assistance Fund Donation - Tax Deductible

Corporate Matching
Many companies will match their employees' monetary contributions to non-profit organizations such as the Homestead High School Music Boosters. You can make your Music Boosters monetary contribution go even farther by taking advantage of your employer's corporate match program. The following amounts are eligible:
** In addition to matching monetary donations, some companies will also make a contribution based on the amount of time you volunteer with Music Boosters. **

Please check with your company to see if they have a matching program for monetary contributions and/or volunteer hours!

If you have questions about corporate matching, please contact the Music Boosters Treasurer (treasurer@homesteadband.org).
Your Employer
Amount eligible for Corporate Match ($)
Are you planning to ask your employer to match your monetary contribution?*

Yes, I will ask my employer for a corporate match.Not sure if my employer offers corporate match.No, my employer doesn't offer corporate match.No, I don't have an amount eligible for corporate match.
Are you planning to ask your employer to match your volunteer hours?*

Yes, I will ask my employer to match my volunteer hours.Not sure if my employer matches volunteer hours.No, my employer doesn't offer matching for volunteer hours.

Membership and Contribution Summary
You have chosen to purchase a membership and/or make a monetary donation to Music Boosters. Thank you for your support!
Music Boosters Membership ($):
Membership amounts above $75 are considered donations and are tax-deductible to the extent allowed by law.
Contribution to Music Boosters ($):
Donations to the HHS Music Boosters are tax deductible to the extent allowed by law.
Donation to the Financial Assistance Fund ($):
Total Amount Due ($):
Making Your Payment
You can pay in one of two ways:
1. Online via PayPal
2. A check mailed to the Music Boosters' post office box or dropped off in the green Band Admin Mailbox in the Homestead Band Room.
Using PayPal incurs a fee of 2.2% + $.31 per transaction. If you decide to pay via PayPal, the transaction fee will be added to your payment. For your transaction, that additional amount ($) is:
Total amount to pay if using PayPal ($):
Total amount to pay if paying by check ($):
How do you want to make your payment?

CheckPayPal

Next Steps
Thank you for taking the time to fill out the registration forms for the Homestead HS Music Department. Please read all the way to the end of this page in order to complete your registration.

The responses you entered into the web form have been automatically entered into a PDF of the corresponding registration forms. You can choose "Preview PDF" to review your responses as they've been placed in the PDF and make any needed changes.

Once you click on "Submit" at the bottom of the page, the data and populated PDFs will be sent automatically to the Band Admin Team and your registration will be complete.

You will have the option to download and/or email a copy of the completed PDF for your records.

If you are purchasing a Music Boosters membership and/or making a financial contribution to the Music Boosters, after you click on "Submit" you will be redirected to a page where you will complete your transaction.

If you have any questions about instrumental music at Homestead, please contact the Band Admin Team at admin@homesteadband.org.

Thanks again for registering for the 2022-2023 school year. We're looking forward to it!

Go Mustangs!
Should be Empty:

	Interested	Maybe	Not Interested
Concerts & Performances (home and away band class events & programs)
Fundraising (direct donation drive, dine out nights, spirit wear, etc)
Event coordination and support
Instrument maintenance or repair
Instrument Inventory management

2022-2023 Homestead HS Instrumental Music Class Forms

Contact Information

Student Health/Medical Information

Parent/Guardian Field Trip Permission and Medical Authorization (Minor)

Athletic/Activity Participation Authorization & Emergency Form

INFORMED CONSENT & SPORTS INJURY RISK WARNING STATEMENT

INSURANCE REQUIREMENTS (Parents must also complete this section)

UNDERSTANDING/AGREEMENT, CONSENT TO TREAT, & WAIVER/RELEASE OF LIABILITY

Parent/Student Agreement Form

BEHAVIOR EXPECTATIONS AND ATTIRE GUIDELINES

Acknowledgement of Important Dates

Photo, Video & Interview Release Form

Music Boosters

Music Boosters Membership

Tax Deductible Donation to Music Boosters

Financial Assistance Fund

Corporate Matching

Volunteering with Music Boosters

Membership and Contribution Summary

Making Your Payment

Next Steps