Student Name *

First Name

Last Name

Student Gender *

Male

Female

Student Cell Phone

(###)

###

####

Allergies? *

No

Yes (explain below)

Plus 1 Course *

Identify the co-requisite course for membership in HTMB. All HTMB students must enroll in period zero Band. All Percussion and Color Guard students must enroll in Period 9.

Period 1 - Concert Band "Tornado Winds"

Period 3 - Hoover String Orchestra

Period 5 - Herbert Hoover Jazz

Period 9 - Drum Corps/Color Guard

Student Shirt Size *

Extra Small

Small

Medium

Large

Extra Large

Student Special Diet *

None

Vegetarian

Vegan

Parent/Guardian 1 *

First Name

Last Name

Parent/Guardian 1 Cell Phone *

(###)

###

####

Parent/Guardian 2

First Name

Last Name

Parent/Guardian 2 Cell Phone

(###)

###

####

STUDENT MUST READ & ACKNOWLEDGE *

I, the student listed above, acknowledge the rules and regulations that have been set forth in the 2018-2019 Handbook. I further understand that all rules and regulations will be strictly enforced and any infractions will be dealt with by the Director.

I read and agree with the above statement.

PARENTS/GUARDIANS MUST READ & AGREE *

The above student has my permission to participate in the administrative approved field trips (times, dates, locations, and events on calendar section of www.hooverband.net) for the 2018/19 school year. The supervising teacher will be Mr. Rhees. The method of transportation will be school bus (walking if to Toll or Keppel). Alternative transportation- if needed- such as personal automobile, city bus, taxi, or charter bus will be taken care of on a separate form. I understand if my child needs to take prescription or over the counter medication during the time he/she is participating in the field trip, that specific guidelines must be followed as per the GUSD health and medication form. I further understand that, under section 35330 of the California Education Code, all persons making such a field trip or excursion shall be deemed to have waived all claims against the Glendale Unified School District or the State of California for injury, accident, illness or death occurring during or by reason of the field trip or excursion. In case of an emergency during the field trip, I or a family member can be reached at the phone numbers provided in this form. I also acknowledge the rules and regulations that have been set forth in the 2018-2019 Handbook. I am financially responsible for all charges incurred while the above student participates with any of the programs of the Herbert Hoover High School Instrumental Music Program. All fair-share donations for travel and other charges must be satisfied as agreed per the payment schedule.

I read and agree with the above statement.

Emergency Contact 1 *

First Name

Last Name

Emergency Contact 1 Phone *

(###)

###

####

Emergency Contact 2

First Name

Last Name

Emergency Contact 2 Phone

(###)

###

####

Parent/Guardian Authorizing *

First Name

Last Name

Fair Share Donation Options *

All Hoover Instrumental Music courses are available at NO cost to Hoover students willing to participate. A large portion of expenses of HIM's high quality offerings are NOT paid by the Glendale Unified School District. Parents and HIM Boosters help with paying for the expenses. The fair share donation allows the music program to be available at its current high quality level which has won many awards in the past ten years. All options, unless noted, require participation in fundraising. Donations start on July 31 and can be made by cash, check (made payable to HIMB), or credit card via the donate button on www.hooverband.net.

Zero payment

Full Support one-time $950 (No fundraising required)

Full Support one-time $375

Two Monthly Installments $380 ($200+$180)

Three Monthly Installments $400 ($200+$100+$100)

Five Monthly Installments $425 (5x $85)

Select to Order

Music Instrument Rentals are suggested donations.

Music Instrument Rentals (1st semester) $35

Music Instrument Rentals (2nd semester) $35

Jacket $100

White HTMB Baseball Cap $20

Black Show T-Shirt (extra) $15

White Rehearsal T-Shirt (extra) $15

Purple Polo Shirt (extra) $35

Battle Grey T-Shirt $15

Black Cotton Gloves $4