CONTENTS: SUMMER 2021 PRIDE BAND NEWSLETTER …

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SUMMER 2021 PRIDE BAND NEWSLETTER SUMMER 2021 PRIDE BAND NEWSLETTER Dear PRIDE Band, I hope that everyone is having a great summer. If you are reading this, it can only mean one thing - preparations for the 2021 marching season are in full gear! I want to encourage everyone to take some time to carefully read all of the information contained within this summer newsletter. Please share this information, especially our performance calendar, with your family and friends. You will notice that we have a schedule filled with wonderful performance opportunities, including exhi- bition performances at Ozarko, Nixa, northwest Arkansas, and San Antonio!!! We were also recently invited to participate in the bicentennial parade for the state of Missouri. All of these performances, in addition to our performances at our Bears home football games, will be great exposure for our program and all of Missouri State. To our returning members, it is your hard work and dedication that continue to raise the bar and allow us to achieve our performance goals. This year is going to be exciting, and I am thrilled that you have chosen to continue this amazing journey. To our new members, you are now part of an organization that will shape the rest of your life. The bonds that you make, and the life lessons you will learn will trans- form who you are as a person. Our veteran members are eager to meet you and to begin showing you what it takes to be a Pride Band member. At this point, everyone should have the link to their section’s music and audio files. Check these links weekly for any updates. We want every member of the band to arrive at camp in good playing shape and ready to go! Our directors, senior staff, junior staff, and our entire leadership team are ready to celebrate our full return to campus! Together, we will set the standard for all future generations of the Pride Band!!! If you have any questions, please do not hesitate to contact us. Go Bears! Dr. Brad Snow Director of Athletic Bands CONTENTS: Director Letter Camp Schedule Drum Majors Letter Camp Tips & Rehearsal Attire Planning Your Finances Course Registration & Rehearsal Schedule Concert Band Auditions Leadership Team Fall Schedule Covid Updates Important Numbers Band Staff Best Year Ever Entertainment Groups & Pep Bands Drum Corps Members Pride Band Apparel Order Form Release / Indemnity Agreement Student Health History Likeness Release Form WWW: missouristate.edu/band Facebook: MSUBand/ Twitter: @MSUPride Bands Instagram: @missouristatebands Email: [email protected] Ph: 417-836-5454 1 2 4 4 5 5 5 6 7 8 8 8 9 9 9 10 11 12 13 14 1

Transcript of CONTENTS: SUMMER 2021 PRIDE BAND NEWSLETTER …

SUMMER 2021 PRIDE BAND NEWSLETTERSUMMER 2021 PRIDE BAND NEWSLETTERDear PRIDE Band,

I hope that everyone is having a great summer. If you are reading this, it can only mean one thing - preparations for the 2021 marching season are in full gear! I want to encourage everyone to take some time to carefully read all of the information contained within this summer newsletter. Please share this information, especially our performance calendar, with your family and friends. You will notice that we have a schedule filled with wonderful performance opportunities, including exhi-bition performances at Ozarko, Nixa, northwest Arkansas, and San Antonio!!! We were also recently invited to participate in the bicentennial parade for the state of Missouri. All of these performances, in addition to our performances at our Bears home football games, will be great exposure for our program and all of Missouri State.

To our returning members, it is your hard work and dedication that continue to raise the bar and allow us to achieve our performance goals. This year is going to be exciting, and I am thrilled that you have chosen to continue this amazing journey.

To our new members, you are now part of an organization that will shape the rest of your life. The bonds that you make, and the life lessons you will learn will trans-form who you are as a person. Our veteran members are eager to meet you and to begin showing you what it takes to be a Pride Band member.

At this point, everyone should have the link to their section’s music and audio files. Check these links weekly for any updates. We want every member of the band to arrive at camp in good playing shape and ready to go!

Our directors, senior staff, junior staff, and our entire leadership team are ready to celebrate our full return to campus! Together, we will set the standard for all future generations of the Pride Band!!!

If you have any questions, please do not hesitate to contact us.

Go Bears!Dr. Brad SnowDirector of Athletic Bands

CONTENTS:Director LetterCamp ScheduleDrum Majors LetterCamp Tips & Rehearsal AttirePlanning Your FinancesCourse Registration & Rehearsal ScheduleConcert Band AuditionsLeadership TeamFall ScheduleCovid UpdatesImportant NumbersBand StaffBest Year EverEntertainment Groups & Pep BandsDrum Corps MembersPride Band ApparelOrder FormRelease / Indemnity AgreementStudent Health HistoryLikeness Release Form

WWW: missouristate.edu/bandFacebook: MSUBand/Twitter: @MSUPride BandsInstagram: @missouristatebandsEmail: [email protected]: 417-836-5454

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2021 BAND CAMP SCHEDULE2021 BAND CAMP SCHEDULESunday, August 15 Check in to Residence Halls! Band students who have a fall campus housing contract will be allowed to move in to the residence halls on Sunday, August 15 (you must sign up for a move-in time in advance!). Once you are checked in on the 15th, your day/evening will be free to unpack, organize your room, etc. Our only focus for Sunday is that you travel to campus, and get settled in your room.

Monday, August 168:00am - Noon Student Leadership Training / Work Day WBH Lunch (on your own)1:30pm Guard / Percussion Rehearsal2:00pm Check-in / Testing / Instrument checkout / Lockers / Shoe Fitting WBH Check-in will take place according to the following schedule. 2:00pm All Woodwinds (Flutes / Clarinets / Saxophones) WBH3:30pm All Brass (Trumpets / Mellophones / Trombones / Baritones / Tubas) WBH5:00pm Dinner (on your own)6:30pm General Meeting WBH 7:00pm Sectionals WBH8:00pm Full Ensemble WBH

Tuesday, August 178:30am Full Band Drill Rehearsal PRIDE Field11:30am Lunch (provided)1:30pm Sectionals TBA3:30pm Winds and Drumline WBH Guard TBA5:00pm Dinner (on your own)6:30pm Full Band Drill Rehearsal PRIDE Field8:30pm Dismissed!

Wednesday, August 188:30am Full Band Drill Rehearsal PRIDE Field11:30am Lunch (on your own)1:30pm Sectionals TBA3:30pm Winds and Drumline WBH Guard TBA5:00pm Dinner (on your own)6:30pm Full Band Drill Rehearsal PRIDE Field8:30pm Band Activity TBA

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Thursday, August 198:30am Full Band Drill Rehearsal PRIDE Field11:30am Lunch (on your own)1:30pm Sectionals TBA3:30pm Winds and Drumline WBH Guard TBA5:00pm Dinner (on your own)6:30pm Full Band Drill Rehearsal PRIDE Field8:30pm Band Activity TBA

Friday, August 208:30am Full Band Drill Rehearsal / Concert-on-the-Green Rehearsal PRIDE Field11:30am Lunch (on your own)2-4:00pm Rehearsal for NEW STUDENT CONVO Arena6:00pm End of Camp Celebration (dinner included) WBH (Everyone attends!!!) Saturday, August 219:00am TBAAfternoon Section Activities - fun!!Evening Free time!!

Sunday, August 2212:30pm Warm-up in sectionals WBH2:00pm NEW STUDENT CONVO Arena (Warm-weather uniform)6:00pm Sectionals Carrington Quad7:00pm Troop to CONCERT-ON-THE-GREEN PSC (Warm-weather uniform)

THIS SCHEDULE IS TENTATIVE. TIMES AND LOCATIONS ARE SUBJECT TO CHANGE BASED ON WEATHER AND AVAILABILITY.

2021 BAND CAMP SCHEDULE (continued)2021 BAND CAMP SCHEDULE (continued)

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CAMP TIPS & REHEARSAL ATTIRECAMP TIPS & REHEARSAL ATTIRE1. Pack camp clothes separate from the clothes you bring for fall, so you don’t have to unpack everything at once.2. Bring comfortable clothes for rehearsals (shorts, t-shirts, etc.) and plan to protect yourself from the hot sun. Ball caps, visors, sunscreen, sunglasses are a must. We encourage light-colored clothing when rehearsing outside.3. Tennis shoes are to be worn at all times. Flip-flops, sandals, dress shoes, boots, bare feet, etc. will not be allowed at any time during marching rehearsal.4. Arrive at camp READY TO PLAY! Be sure to practice daily the week prior to your arrival to camp. You must be in good physical condition for camp and have your “chops” up, or you will experience a great deal of discomfort throughout camp. Color Guard: Practice on your equipment prior to camp so your muscles are ready and your stamina is strong.5. A full tank-top or full t-shirt is acceptable for rehearsals. Sports bras, bikini tops, tube tops, etc. are not considered appropriate.6. The cut of pants/shorts should be high in the waist. The length of shorts should be appropriate and conducive to physical activity.7. Make sure you have a portable charger on you at all times. We will be utilizing Ultimate Drill Brook for all of our drill charts and coordinates, and the Flip Folder App for music. You need to make sure that your phone is always charged in order to access music and drill materials.8. Each member of the band is expected to provide their own water bottle/jug for all outdoor rehearsals. Please have your name written on your water bottle.

FROM THE DRUM MAJORS...FROM THE DRUM MAJORS... Hello! The 2021 Marching Season is quickly approaching, and we are overjoyed to welcome back both veteran marchers as well as new members to be a part of the PRIDE Band!

The PRIDE Band has worked together through many of our best and toughest times as a family, and we know with absolute confidence that you will find your place among our expansive community. It is our hope that you find a sense of pride and accomplishment this coming season, as many have before you.

Our community is comprised of over 300 members originating from a large variety of backgrounds, making it a home for everybody. The memories we make and the moments we share with our fellow bandsmen will be cherished long after our marching days are over, and together we can make this next season unforgettable! We look forward to another season of hard work and dedication as we continue to uphold our traditions and break new ground together. To our vets, we cannot wait to welcome you back with open arms as we demonstrate what makes the PRIDE Band amazing, and to the rookies we are so excited for you to join our family and take the first steps towards a prosperous future! This next year will be full of new opportunities and adventures that will bring us together more than ever. We look forward to seeing you all on campus in August! Go Bears! Your Drum Majors - - Carson Hewit, Katie Johnson, Bryan Paat, Melissa Tate

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PLANNING YOUR FINANCESPLANNING YOUR FINANCES1. You will be billed by the University for the Band Camp / Travel Assessment in the amount of $450. This one-time figure pays for: * warm weather uniform * end-of-season banquet (shirt / shorts / belt / ball cap / marching shoes) * travel * uniform maintenance and repair * instrument / equipment usage fee * some meals during camp2. Color Guard members will be billed an additional $160 to cover the cost of the fall costume and necessary equipment. 3. Drumline (battery and front ensemble) will be billed an additional $60 to help cover the cost of practice and performance mallets, sticks and head replacements.4. Lockers may be rented in Wehr Band Hall for $20 per semester. It is strongly encouraged that all university-owned instruments be kept in lockers.

COURSE REGISTRATION & FALL REHEARSAL TIMESCOURSE REGISTRATION & FALL REHEARSAL TIMES

Course Registration: MUS 177-001 CRN 45997 (freshmen / sophomores)MUS 377-001 CRN 45998 (juniors / seniors)MUS 675-001 CRN 42553 (graduate students)

CONCERT BAND AUDITIONSCONCERT BAND AUDITIONSConcert Band Auditions are scheduled for Wednesday (August 18), Thursday (August 19) and Saturday (August 21). Sign-up sheets will be posted (August 1) in the band office. Please visit the Concert Ensemble Audition Material link for further information (missouristate.edu/band).

Wednesday, August 18 Thursday, August 19 Saturday, August 2111:00am-11:45am -- Oboe/Bassoon 11:30am-2:15pm -- Low Brass 9:00am-12:00pm -- make up if needed12:00-1:30pm -- Flute 2:15-3:45pm -- Trumpet 1:00-3:00pm -- Percussion1:45-3:30pm -- Clarinet 5:00-6:30pm -- Horn5:00-6:15pm -- Saxophone

Fall Class / Rehearsal Schedule:MW 3:30-5:00pmTR 5:45-6:45pmF 3:30-5:45pm

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2021 PRIDE BAND STUDENT LEADERSHIP TEAM2021 PRIDE BAND STUDENT LEADERSHIP TEAMGRADUATE ASSISTANTSJeremy LouiAndrew ReaderCaleb TaylorElisa Wren

MARCHING STAFFChris ChurchGabe Fleetwood - Front EnsembleLiam Wilson - PercussionLauren Byrne - Color GuardJimmy Carotenuti - Color Guard

DRUM MAJORSCarson Hewitt – HeadKatie JohnsonBryan PaatMelissa Tate

FLUTE / PICCOLORebecca James - Co-Head / MusicKenzie Jenkins - Co-Head / VisualLaura Adams - CommunicatorKassidy Wagner - MentorSarah Bolander - Co-SocialMariah Alberty - Co-Social

CLARINETEsperanza Aguilar - Head / Co-MusicHannah Scarborough - Co-MusicAlyssa Miller - VisualDrake Simonds - CommunicatorEmily Snodderly - MentorKristen Dennis - Social

SAXOPHONEDinah Hotz – Head / Music (Bari)Philip Canole – Music (Alto) / SocialBlake Hosman - Music (Tenor)Allison Clements - Visual (Alto)Maggie Moncado - Visual (Tenor)Austin Wilson - Visual (Bari) / CommunicatorLuke Emmert - Mentor

TRUMPETJackson Dampier - Head / VisualMarcellus Weinzerl - Co-MusicRobert Offutt - Co-MusicTyler Barton - Communicator / Co-SocialJordan Mosley - Mentor / Co-Social

MELLOPHONEVincent Tosatto - Head / MusicRachel Hanks - VisualElizabeth Hansen - CommunicatorJackson Jobe - MentorRebecca Allen - Social

TROMBONETyler Textor - Co-Head / MusicMax Brower - Co-Head / VisualAllan Mitchell - Communicator / Social

BARITONEDarcy Skillington - Head / Mentor (all Low Brass) / Communicator / Co-SocialCorrie Carnahan - Music / Visual / Co-Social

TUBAEric Strange - Head / Visual / CommunicatorTrey Tisone - Music / Social

PERCUSSIONBen Zweerink - Head / Snare LeadZach Reynolds - TenorCarson Wilkins - Bass LeadGavin Remstedt - Cymbal Lead / CommunicatorVal Kaiser - Front Ensemble Lead / CommunicatorMarlin Allen - SocialGunnar Ecklund - Mentor

COLOR GUARD CAPTAINSSarah BentonIsabelle HaaseAcacia Jurkowski

COLOR GUARD VISUALEmily CarriereAvery McCorkleMadison Swim

COLOR GUARD COMMUNICATORCandace GerbigAmanda RawlsAmanda Schulz

COLOR GUARD MENTORAvery BurtonIsabella EslickAmanda Lynch

COLOR GUARD ACADEMICSol KieschnickLauren PowellElizabeth Tapen

COLOR GUARD SOCIALAllison BartonAmelia HarmonKaitlyn JohnsAustin Smith

PRIDE BAND STUDENT SUCCSSS FACILITATORSol Kieschnick

PRIDE BAND ATTENDANCE MANAGERKatherine Wichern

PRIDE BAND OTC LIAISONLauren Powell

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Sunday, August 15 - Sunday, August 22

Sunday, August 22

Sunday, August 22

Friday, August 27

Saturday, September 11

Saturday, September 18

Saturday, September 18

Saturday, September 25

* Friday, October 8

* Saturday, October 9 (please note OZARKO is over Fall Break)

Thursday, October 14

Saturday, October 16 – Homecoming!!!

Tuesday, October 19

Saturday, October 30

Thursday, November 4 - Sunday, November 7

Thursday, November 11 (tentative)

Saturday, November 13

Sunday, November 14

2021 PRIDE BAND FALL SCHEDULE2021 PRIDE BAND FALL SCHEDULE

• PRIDE Band “Boot Camp”

• New Student Convocation - Arena @ 2:00pm

• Concert on the Green – PSC @ 7:00pm

• extended rehearsal with Lindsey Vento on body movement - 3:30-6:30pm

• MSU Home Football Game vs. Univ of Central Arkansas – PSC - 7pm

• Missouri’s Bicentennial Parade - Jefferson City - 10am

• Exhibition Performance at Palen Band Xhibition – Nixa HS – evening

• MSU Home Football Game vs. Univ of South Dakota – PSC - 7pm

• OZARKO Prep & Stadium Rehearsal - PSC - TBA

• OZARKO Marching Festival – PSC, all day / eve

• Homecoming Pep Rally – TBA

• Parade – 9:00am• MSU Home Football Game vs. Indiana State Univ – PSC @ 2:00pm

• Exhibition Performance at Northwest Arkansas Region VI Event - Rogers HS - evening

• MSU Home Football Game vs. Univ of North Dakota – PSC - 2pm

• Band Trip to San Antonio, Texas - Exhibition Performance Bands of America Super Regional - Alamodome (Saturday, November 6 - TBA)

• TAPS Project (PRIDE Trumpet Section) – McDonald Steps @ 11:00am

• MSU Home Football Game vs. Univ of Northern Iowa – PSC - 2pm

• Band Parents Banquet – The Oasis Convention Center @ 12:00pm

ALL DATES AND TIME LISTED BELOW ARE SUBJECT TO CHANGE This list should only serve as a tentative sched-ule to help you plan your fall semester. A finalized performance schedule will be published the first complete week of classes.

BARITONEDarcy Skillington - Head / Mentor (all Low Brass) / Communicator / Co-SocialCorrie Carnahan - Music / Visual / Co-Social

TUBAEric Strange - Head / Visual / CommunicatorTrey Tisone - Music / Social

PERCUSSIONBen Zweerink - Head / Snare LeadZach Reynolds - TenorCarson Wilkins - Bass LeadGavin Remstedt - Cymbal Lead / CommunicatorVal Kaiser - Front Ensemble Lead / CommunicatorMarlin Allen - SocialGunnar Ecklund - Mentor

COLOR GUARD CAPTAINSSarah BentonIsabelle HaaseAcacia Jurkowski

COLOR GUARD VISUALEmily CarriereAvery McCorkleMadison Swim

COLOR GUARD COMMUNICATORCandace GerbigAmanda RawlsAmanda Schulz

COLOR GUARD MENTORAvery BurtonIsabella EslickAmanda Lynch

COLOR GUARD ACADEMICSol KieschnickLauren PowellElizabeth Tapen

COLOR GUARD SOCIALAllison BartonAmelia HarmonKaitlyn JohnsAustin Smith

PRIDE BAND STUDENT SUCCSSS FACILITATORSol Kieschnick

PRIDE BAND ATTENDANCE MANAGERKatherine Wichern

PRIDE BAND OTC LIAISONLauren Powell

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IMPORTANT PHONE NUMBERSIMPORTANT PHONE NUMBERSBand Office: 417-836-5454Campus Operator: 417-836-5000Campus Security: 417-836-5509Counseling Center: 417-836-5116Bear CLAW (Center for Learning & Writing): 417-836-6398

PRIDE BAND STAFFPRIDE BAND STAFFDR. BRAD SNOW - Director of Athletic Bands [email protected]

DR. JOHN ZASTOUPIL - Director of Concert Bands [email protected]

Bookstore: 417-836-5403Financial Aid: 417-836-5262Residence Life: 417-836-5536Magers Health & Wellness Center: 417-836-4000MSU Tix: 417-836-7678

JOHN SULLIVAN - Color Guard Director - [email protected] SULLIVAN - Band Support Specialist - [email protected] PERKINS - Band Event Coordinator - [email protected]

COVID UPDATESCOVID UPDATES

RESPONSE / MASKING / VACCINATIONS / TESTING / MITIGATION (as it relates to Band)The band program will continue to follow all university guidelines and policies. For the latest COVID-19 information at MSU, please refer to: Missouristate.edu/coronavirus

MaskingAt the present time, there is no masking policy on campus. We encourage individuals who feel more comfortable or are unvaccinated to wear a mask, although masking is no longer required.

VaccinationsBand members are not required to be vaccinated.

Band members who are vaccinated should provide the band office with a copy of his/her vaccination card as we are required to have “date of last dose” on file in the event a booster is required.

• Benefits of being Vaccinated: • arrive for band camp without a pre-test • band travel without a pre-test or post-travel test • band travel without quarantining after travel • if you have been exposed to someone who has COVID-19, you do not need to quarantine or get tested unless you develop symptoms

• Implications of not being Vaccinated: • unvaccinated band members will be required to provide a negative COVID-19 antigen or PCR test upon arrival at camp, taken no earlier than three days prior, OR take a rapid test at Wehr Band Hall on Monday morning August 16, before being allowed to start camp (if you check into the residence halls on Sunday, August 15, your testing will be conducted at that time) • unvaccinated bandsmen will be required to take a COVID test (with negative result) before any fall season travel, which includes all three off-campus performance events listed on the fall performance schedule.

MAKE THIS YOUR BEST YEAR EVER!MAKE THIS YOUR BEST YEAR EVER!When students enter college they tend to believe that everyone graduates, but more often than not it takes more than four years, and many individuals do not complete a degree program. We are here to help you. College is serious business but it is worth the effort. So, prepare yourself for success by doing the following:

• Set appropriate goals.• Balance your class load - - 12-15 hours is a full load.• Wait to join a fraternity or sorority until you’ve become acclimated to college life.• Limit or eliminate employment obligations.• Make healthy choices - take care of yourself.• Don’t drink! Alcohol robs you of your initiative and is harmful to your health.• Sleep 8 hours each night (staying up too late takes a toll).• GO TO CLASS! Regular attendance pays off. Make friends with classmates.• Keep up with homework! Don’t procrastinate.• Expect to study. Grades follow you forever.• Practice! Daily practice will move you ahead musically.• Communication is key. Don’t hesitate to meet with the instructor.• Keep track of your obligations - - performances, exams, class projects, etc.• Live on a budget. Debt accumulates quickly when you are on your own.• Remember: SCHOOL COMES FIRST! This is the time to educate yourself for a brilliant career.• Be positive. Positive people live longer, feel better and are more pleasant to be around.• Be a responsible adult. Honor the commitments you have taken on.• Embrace a strong work ethic.• Demand self-discipline of yourself. Only you will know your “true self.” You make your own decisions. Be someone you can be proud of. WORK AT IT!• Nurture a foundation of faith. Students often starve themselves spiritually during their college years. A strong faith base will serve you well in the college community and throughout your life.• Live a “life of promise” on campus to assure a good life after graduation.

ENTERTAINMENT BANDS & PEP BANDSENTERTAINMENT BANDS & PEP BANDSAuditions for these groups take place during band camp. Audition music will consist of the Fight Song and basic scales. (Optional Course Registration for Bear Mania members: MUS 175 / 375, Section 1 (CRN 56731 / 57160).)

DRUM CORPS MEMBERSDRUM CORPS MEMBERSPlease notify the band office (417-836-5454 / [email protected]) if you are marching with a drum corps this summer. All drum corps members are expected to be at band camp immediately upon completion of DCI finals.

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Orders will be accepted until Friday, August 20.

Merchandise will arrive and be ready for pick up on Saturday, September 11, in Wehr Band Hall from 4:00-5:30pm.

Missouri State UniversityPRIDE BAND

Apparel Available to Purchase for a “LIMITED TIME ONLY!”

MISSOURI STATE PRIDE BAND

Missouri State University PRIDE BAND

- 2021 "Optional" Apparel Order Form -

Name: ---------------------Phone: ---------------------Em ail: ---------------------Circle one: Current Pride Bandsman Pride Band Fan

ITEM SIZES QUANTITY COST

Pride Band "Dad" T-shirt S-XL $13

Maroon with white & grey print 2XL-4XL $16

Pride Band "Mom" T-shirt S-XL $13

Maroon with white & grey print 2XL-4XL $16

Pride Band "Grandparent" T-shirt S-XL $13

Maroon with white & grey print 2XL-4XL $16

Pride Band Sweatshirt S-XL $30

Dark Heather Grey with maroon & white print 2XL-4XL $33

Pride Band T-shirt S-XL $13

Maroon with grey print 2XL-4XL $16

Pride Band Long Sleeve T-shirt S-XL $18

Dark Heather Grey with maroon & white print ( on sleeve) 2XL-4XL $21

Pride Band Sweatshirt S-XL $35

Maroon with white & black print 2XL-4XL $38

Pride Band Bearhead Ball Cap $13

Maroon with white and grey embroidery

TOTAL

Mail order form with check (made payable to: MSU Band) to:Wehr Band Hall - MSU 901 South National Ave. Springfield, MO 65897

GRAND TOTAL: ___ _

Order deadline: Friday, August 20, 2021 11

STUDENT HEALTH HISTORY

Name ___________________________________________ M# _____________________ Have you received the COVID vaccination? (circle one) YES NO If you have received the COVID vaccination, please attach a copy of your vaccination card, or bring the card to camp with you and we will make a copy. HEALTH HISTORY (please give dates where known): • Operation (within last year) ________________________________________________ • Emotional Problem (hyperventilator, hysteria) _________________________________ • Serious Medical Problems _________________________________________________ • Rheumatic Fever _________________________________________________________ • Diabetes _______________________________________________________________ • Epilepsy ________________________________________________________________ • Allergy _________________________________________________________________ • Tetanus (last injection) ____________________________________________________ • Allergy to Drugs (specify i.e. penicillin, insulin, etc.) _____________________________ • Tranquilizers ____________________________________________________________ • Is student under medical treatment at present? _______ (Reason) _________________ • Specific Dietary Needs (gluten free, vegetarian, etc.) _____________________________ ________________________________________________________________________ ________________________________________________________________________ • Physician _____________________________ Physician Phone # ____________________

This information will remain confidential and only used in an emergency.