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Navo Middle School
Navo Middle School
Manual of Policies and Procedures
2018-2019The Theatre Arts Department of
Navo Middle School
Manual of Policies and Procedures
The purpose of this manual is to clearly define the necessary rules and accepted practices of the Navo Middle School Theatre Arts Department. It is the goal that the
productions and the experiences for all involved (performers, technicians, crews, faculty, and audiences) will be more rewarding because of everyone's commitment to
excellence.
**Students wishing to participate in a Navo Theatre productions need to clearly understand all sections of the Navo Theatre Manual of Policies and Procedures
and will be held accountable for this information.**
FacultyAmanda Hirsch- Director
Baily Atkinson- Asst. Director
The 2018-2019 Officer Board
President- Elizabeth Welch
Vice President- Jasmine Waititu
Secretary- Alyson Staiger
Publicity- Hannah Reid
Treasurer- Hannah Blake
Alternate Officers:
Madison Hamby
Navo Middle School Mission
The mission of Navo Middle School, in collaboration and open communication with the learning community, is to empower our students to become self-confident, respectful, and
responsible citizens through maintaining high expectations, embracing diversity, and providing a safe, positive learning environment.
Fear causes hesitation, and hesitation causes your greatest fears to come true. A theater is a place for plays to be crafted, not for play. Theatre is a refuge where we can escape life’s problems - not let them interfere with
Navo Theatre Mission Statement
We have a commitment to excellence, a challenge that we demand to meet with each day. We seek not only excellence in the art itself, but also in our toiling, training and tenacity. We
believe that a production is not a product of any one classification of people whether it be crew, actors, directors, audience- but rather a union of the passion and appreciation between all of the aforementioned groups. This department offers not only an opportunity to grow as an artist, but more importantly, to develop skills that will empower you throughout your life.
We will challenge all members to take risks, push their own limitations and strive to grow beyond themselves. We must always remember that outstanding productions are the result of
a synergy between all of the above elements.
International Thespian Society Pledge
“I promise to uphold the aims and ideals of The International Thespian Society. I am a student of theatre and
excellence is my ideal. I promise to perform my part as well as I can; to accept praise and criticism with grace; to
cooperate with my fellow Thespians and work for the good of the troupe; and to share my love of theatre. Act well
your part, there all the honor lies.”
Philosophies of the Navo Middle School Theatre Department
A theater is a mecca where art is created – treat it with reverence and respect.
the process of creation. Having fun in theatre is a result of putting forth effort, being disciplined, and doing
the job correctly. The rewards far exceed those that come from simply being adequate, sliding by or just throwing it together.
Never come into the Theatre with mud on your feet. Leave your dust and dirt outside. Check your little worries, squabbles and difficulties - all the things that ruin your life and draw your attention away from your art - at the door.
You will be pushed to do your best; we expect you to work consistently, try hard, obey the rules and cooperate fully with your directors and fellow performers. This will be made easier if you remember the following:
Table of Contents
A. General ProceduresB. Academic ResponsibilitiesC. Basic Rules of the StageD. Attendance and PromptnessE. Auditioning ProceduresF. General Rehearsal and PerformanceRulesG. Actor Rehearsal and PerformanceProceduresH. Crew Rehearsal and PerformanceProceduresJ. Rehearsal Schedule
K. Performance EtiquetteL. Dress Room RulesM. StrikeN. Hair PolicyO. Procedures for Box OfficeP. Usher and House Staff ProceduresQ. Travel GuidelinesR. Thespian Membership and PointPolicyS. Jr. Players MembershipT. Social MediaAppendix 1. Infractions andConsequence
A. GENERAL PROCEDURES1. All Navo Theatre participants must follow ALL directives and meet ALL deadlines of the
Directors and Navo Theatre Officers. Following directives means responding with “Yes sir/Yes ma’am”, and or “Thank you” and completing the directive the first time asked with a positive attitude. Excuses or questioning will not be tolerated.
2. Behavior and image are two important factors for Navo Theatre students because we are continuously on display. Students should not take part in or continuously engage in any on or off-campus activity that could be perceived as diminishing the integrity of Navo Theatre. This would include electronic messages either in text or online.
3. All participants must check the callboard DAILY for announcements. Negligence in reading the callboard is no excuse for missing an assignment or rehearsal. All efforts will be made to post all announcements before lunch.
4. The students that are staying in the building for Navo Theatre events must be with Mrs.Hirsch at all times.
5. Due to the fear of cross contamination and the spreading of disease, the sharing of food, drink, or make-up is adamantly discouraged.
6. Navo Theatre equipment should only be used with permission from a Director, and it should be returned to its appropriate place when the work is completed at day’s end.
7. Students who have financial obligations will be ineligible for casting and unable to check out Navo Theatre equipment.
8. Students in Chambers must have a signed pass from their teacher unless they are in a class in Chambers during that period.
9. Three major rules concerning communication:1) It is your responsibility to be informed.2) Never assume anything. Don’t rely on word of mouth.3) Check the callboard DAILY!
B. ACADEMIC RESPONSIBILITIES1. Your primary responsibility is to your grades. When you are involved in a Navo Theatre
activity, it is your responsibility to let us know if you are having trouble in a particular class so that we can arrange tutoring. We cannot provide help unless you inform us that there is a problem. Remember: if you fail, you will be ineligible. It will then be extremely difficult for you to regain the trust it takes to participate in activities.
C. BASIC RULES OF THE STAGE
1. Do not eat or drink anything on the stage or in the auditorium! 2. As questions and concerns will inevitably arise, see the Stage Manager after rehearsal.3. Spectators and children from the audience are not allowed to be on the stage at any time
before, during, or after the production.4. The lip in the auditorium is not to be walked on, stood on, sat upon, or crossed except
when blocked to do so in the action of the play.5. Jumping on/off the stage is unacceptable except when blocked to do by the Director.6. The fronts of the stage curtains are not to be touched by human skin.
D. ATTENDANCE AND PROMPTNESS1. Be on time to rehearsal! This is an important rule of the theatre! Call time is usually
fifteen minutes before rehearsal and 2.5 hours before performance. If you are a minute late to rehearsal, then you are still late. If you need to be tardy due to a valid reason, use the same procedure as you would for an absence. If rehearsal starts at 7:30am, you are expected to arrive at 7:20am to set props, dress in attire and warm-up as a cast so that rehearsal can start promptly.
2. On the third unexcused tardy, the student will be removed from the production. 3. Three excused tardies will be count as one unexcused absence.4. One unexcused absence or three excused absences (non-school/work) from rehearsal
will result in dismissal pending Director conference. An unexcused absence from a dress rehearsal or performance is an automatic dismissal and will most likely keep you from being selected for future Navo Theatre productions.
5. A tentative schedule of rehearsal days and times will be at the audition. You will be asked to fill out a conflict sheet that tells the Director(s) when you cannot be at a particular rehearsal. Please be specific and accurate on the conflict sheet! Write in all school related, job related or church related conflicts. If the conflict is not on this list, it will be considered unexcused.
6. If you have a valid reason for missing a rehearsal, notify the Director at least three days prior so that the rehearsal schedule may be modified. If you have an emergency absence on the day of a rehearsal, then contact your Director immediately. If needed, leave a message! Never tell someone else to tell the Director. It is your responsibility to contact the director(s).
7. Students may not leave rehearsal early without the Director’s permission.8. Students are expected to communicate any attendance issues to the Stage Manager once
approved by the Director.
E. AUDITIONING PROCEDURES1. Within 24 hours of posting, you must initial the cast list next to your name to accept
your part. Not doing so may result in a recasting of your role.2. If a student declines their part, the student may be ineligible for casting in the following
Navo Theatre production.3. Once the cast list is posted, it is considered inappropriate and unprofessional to inform
others of their parts. 4. If you do not get cast in a role that you desire, learn to accept the loss with grace. Verbal
attacks or gossip serve no constructive purpose.
F. GENERAL REHEARSAL AND PERFORMANCE RULES1. Any form of graffiti in and around the school will not be tolerated.2. All production participants should be prepared to perform assigned role/duties at
rehearsals, crews and performances.3. Trash left in and around the area will not be tolerated. Please clean up after yourself, and,
if necessary, others.4. Visitors (friends of cast/crew, siblings, school photographers, newspaper media, etc.)
attending rehearsals will be allowed only by prior permission from the Director. 5. All students involved in a production must participate in strike with the exception of
House Staff, who are encouraged to attend. Thespian points will not be awarded to the student until triple the time of strike they missed is made up; however, if a student misses strike due to a pre-approved school sponsored event, they are only required to make up the time of strike missed.
G. ACTOR REHEARSAL AND PERFORMANCE PROCEDURES1. Be on time to every rehearsal prepared to work; not entering with food/drink.2. Silence MUST be maintained backstage at all times.3. Actors must follow all instructions by the Directors and Stage Manager, and cooperate
with other actors, technicians, and participants in the production.4. Costume repairs should be reported to the costume mistress.5. Eating and/or drinking in costume is strictly forbidden.6. Actors are responsible for scripts (and scores if applicable) at all times and must have
these and pencils with them at every rehearsal. Failure to return a script or score when necessary may result in fines.
7. All company members must maintain a quiet, professional attitude at all times.8. Props are to be used only in the given action of a play. Actors should pick up all props
from the assigned prop areas and return them as directed. No props are to be played with or removed from the stage area.
9. Set pieces should not be moved, played with, touched, or sat upon except in the given action of the play.
10. The actor must cooperate with the Director in the overall “look” of the character. Hairstyles will be dictated by the character, period of the play, and design concept. See the Hair Policy section of this handbook for further explanation.
11. Personal issues should be dealt with outside of the performing and rehearsing times.12. Actors should begin memorizing their lines upon receiving the script. After a scene is
blocked, they should If you are running a scene and do not know your line, pause and call out “Line” and the prompter will give you the beginning of your line. DO NOT “break character.”
13. Memorize lines when not onstage or bring homework or study materials. Never use the production as an excuse for failing grades or not being prepared!
14. Take care of your health! 15. Avoid asking the following questions during rehearsals:
a) How long will rehearsal last?b) Am I really needed today?c) What are we going to do in rehearsal today?d) May I leave early? I only have a small part.
16. Actors are actors. Techies are techies. ALL are essential to the process, but please concern yourself only with your job. Never tell someone else how to do his or her job. It will not be tolerated. Accept your role in the production.
H. CREW REHEARSAL AND PERFORMANCE PROCEDURES1. The technical crew is responsible for the same rehearsal and performance procedures and
expectations as the actors.2. Crew must follow all orders by the Directors and Stage Manager and cooperate with the
actors, other technicians, and participants in the production.3. Stage Manager and Crew Heads should be treated with the same respect as a Director.4. All schedule conflicts, including specific dates and times, should be reported on the
technical contract.5. Crew is required to attend all appropriate crew calls; crew members will only get thespian
points for the crew calls for which they attend.6. Backstage behavior MUST be professional and silent at all times.7. Nothing can be pinned or clamped to the front of the curtains.8. All furniture and scenery must be carried or rolled on the painted stage floor; no dragging
or sliding. All furniture must be put in the proper place at the end of rehearsal or performance.
9. Only technical personnel approved by a Director are permitted in the control booth, in the light lab, on the catwalk, or the costume shop.
10. Only trained and approved personnel are permitted to operate the light/sound boards.11. Only technical personnel approved by a Director may be on headset. The conversation
must be professional and limited to things directly pertaining to the technical aspects of the performance.
12. All microphones and headsets must be properly put up in the designated area at the end of each rehearsal and performance.
13. Make-up and costume crews are the only crew members permitted in the dressing rooms during the dress rehearsal and performance process. They must be performing official make-up and costume duties during specific crew times as specified by a Director or crew head.
14. Student technicians are responsible for the proper use of all equipment.15. Horseplay or improper use of tools is not permitted.16. Only trained and approved personnel are permitted to use power tools.17. Wasting of supplies is not permitted.18. Any tool/utensil used must be properly cleaned and put back in its proper place.19. Crew will not be dismissed until all tools and equipment have been accounted for and
returned to their homes, the work area is clean and a Director has cleared them.20. Actors are actors. Techies are techies. ALL are essential to the process, but please
concern yourself only with your job. Never tell someone else how to do his or her job. It will not be tolerated. Accept your role in the production.
J. REHEARSAL SCHEDULE1. Although each Director has different stop/start times, most rehearsals will take place
from 4-5pm Monday, Wednesday & 7:30-8:40am Friday. You are required to be at these rehearsals unless designated otherwise in the rehearsal schedule. The rehearsal schedule
may be altered to fit the personal schedule of the Director or the schedules of the company.
2. All cast and crew members are required to stay for the Director’s and/or Stage Manager’s notes following dress rehearsals. This usually means rehearsals may last until 10pm the final week. Please inform your parents of these final dress rehearsals and be prepared to stay for the entire length of the rehearsal.
3. It is the responsibility of the cast and crew to clean up your make-up, hang your costumes and put the dressing area back in order each day. No cast/crew member is permitted to leave the building until the Director dismisses everyone.
K. PERFORMANCE ETIQUETTE1. “Breaking Curtain” (peeking out) before the show, during the show, or at intermission is
considered extremely bad etiquette and is not permitted.2. Having visitors (including parents) backstage before, during, or after the show is not
permissible unless pre-approved by a Director.3. Being seen in the house before the performance is not permitted. This includes the house
lobby unless instructed otherwise by a Director.4. Leaving school campus during a performance is not permitted.5. In American theatre, the presentation of gifts and flowers in front of the audience at
curtain call is considered very bad etiquette and is not permitted unless pre-approved.6. The house lobby of the theater is referred to as the “Reception Hall”. It serves as a
location where congratulations, hugs, gifts, and flowers can be exchanged after the performance. This is the most appropriate place for the cast and crew members to greet audience members.
L. DRESSING ROOM RULES1. During the period of dress rehearsals and performances, students are not permitted in the
dressing room of the opposite sex except for approved make-up/costume crew.2. Only cast members or specified crew members are permitted in the dressing room two
hours prior to every performance. No visitors are allowed in the dressing room.3. Departmental make-up and hygienic supplies are to be used only by the performers.4. Each actor is assigned his/her own make-up station and is responsible for cleaning it after
each rehearsal and performance.5. Caps must be placed on their respective containers when finished and makeup applicators
should not be mixed.6. Dressing room mirrors are to remain clean at all times. Any writing or obstructive
decoration on or around them is not permitted. They are there to assist in the physical preparation for a production, not for socializing with other cast members.
7. Costumes WILL BE treated with care. Actors must hang up all costume pieces. Items worn as costumes never leave the theater during the dress rehearsal and performance period, except when taken for cleaning and/or repairs, and only when approved by the costume head. The performer never takes any part of their costume home, even if it is their own property, until strike
8. Sitting, standing, or lying on the dressing room counters is prohibited.9. Stage make-up and costumes are not to be worn after a performance and must be
removed prior to greeting the audience.
10. Food or drink, with the exception of water, is prohibited in the dressing rooms.11. Personal items should be stored away from the counter or left at home.12. All personal items must be removed from dressing rooms by the end of strike. After one
week, they may become departmental property.13. Cast will stay in costume for Photo Call after the open night show.
M. STRIKE1. Everyone in the cast/crew is required to attend strike following the last performance or
the day after. 2. All cast/crew members must sign in with the Stage Manager both at the beginning and
end of strike. No exceptions. You must attend strike and will stay until dismissed.N. HAIR POLICY
1. It is customary in this department that actors NEVER do anything with their hair and/or beards during a particular production. It is the responsibility of the actor to check with the Director as to what look the Director wants. It is wise for actors not to get emotionally attached to a particular hair style or hair color. Failure to abide by this rule could dismiss you from the cast.
2. We are more apt for ladies or men to dye hair than to go with wigs or hair pieces. BE READY TO DYE YOUR HAIR OR CUT IT IF THE ROLE REQUIRES!
O. PROCEDURES FOR BOX OFFICE1. Anyone who sells tickets must go through a Box Office Orientation session.2. Advance ticket price is stopped at 3:00 the day of the performance.3. Reservations by phone should be recorded on the reservation sheet. Messages should be
confirmed prior to the filling of the order. In this call, the caller should confirm how many will be attending and for which performance.
4. All unclaimed tickets are available for resale the night of performance 15 minutes prior to the performance.
5. The tickets for a reservation should be placed in the special sized ticket envelopes. In the top left corner, the ticket seller should write the buyer’s name (last name first), the number of tickets, and the date of the performance. In the top right corner, the ticket seller should write how much the buyer owes before they can pick up their tickets. The envelope should be placed in the appropriate reservation box in alpha order.
6. All tickets and money are to be locked up when not filling orders. The individual tickets are worth as much as the money.
P. USHERS AND HOUSE STAFF PROCEDURES1. All House staff must be dressed in black slacks and a tucked-in, white collared shirt. You
are the first impression of the department and must dress the part.2. Flashlights and Usher tags will be assigned nightly to the House staff and must be turned
in each night to the House Manager.3. The House Staff and house crew must help set up the lobby, including the refreshment
area, and prepare programs before the opening of the house.4. During the course of the show, the Ushers and House Staff are to remain in the
auditorium in their designated areas. They are not allowed backstage.5. All House Staff are to obey the House Manager at all times.
6. Ushers are to enforce all rules stated in the Section C: Basic Rules of the Stage.7. Ushers are to hand out programs, solve problems, handle emergencies and answer any
questions that may be asked by the audience.8. In the event of a disrespectful, unruly, or inappropriate audience member, the Usher is
expected to remain respectful at all times. If the problem cannot be solved, alert the House Manager, Director, or a School Administrator if additional help is necessary.
9. At the end of each performance, the House Staff must clean up the house, lobby, and refreshment areas and return all equipment, including signs, tables, chairs, t-shirts, and programs to their appropriate places before they are dismissed.
10. All House Staff members must be professional, respectful, courteous, and helpful to all audience members at all times. Any disrespect to a theatergoer or the House Manager will not be tolerated!
Q. TRAVEL GUIDELINESTransportation
1. The student shall be prompt in arriving to the designated meeting point for the trip.2. Students shall pack appropriately for the length of the trip.3. Equipment to be packed must be checked to ensure the security of Navo Theatre
property.4. Travelers should respect the rules of the bus driver and be courteous at all times.5. Voices should be kept at an appropriate level for the bus or airplane.6. All trash should be deposited in the appropriate receptacles.
Hotels1. Students shall respect the curfew given by sponsors and/or hotel policy.2. “Lights out” means all lights, including cell phones, laptops and TV are to be of3. Rooms shall be kept clean and neat for the duration of the trip.4. Be respectful of roommates and fellow guests of the hotel.5. Students will not enter the rooms of the opposite sex.6. Any practical jokes, hazing, or inappropriate conduct directed toward another person may
result in serious, if not legal consequences.7. Voices should be kept at an appropriately low level in common areas of the hotel.8. Always pack a swimsuit.9. Students should be prepared to be flexible and plan ahead for showers, dressing, etc. as
permitted.
R. THESPIAN MEMBERSHIP AND POINT POLICY1. To be eligible to become an Official Thespian, ten points (in multiple areas) are required.
If the points are strictly in one area, 10 points are needed. To become an Official Thespian, you must pay dues and be inducted at the Drama Banquet.
2. Points are assigned in a manner based on the intention of the International Thespian Society Points Policy, which states that one point is equivalent to ten hours of work. However, they will be adjusted and fairly distributed on a case-by-case basis.
3. All hours for strike must be completed before points will be awarded for that show.4. Any outstanding fees will result in no points being awarded until fees are paid.5. See The Official JR.High School Thespian Point System document.
S. NAVO MEMBERSHIP1. To be a Navo Theatre member you must have a handbook signature sheet on file.2. In order for Navo Theatre members to vote for officer elections they must have attended
7 meetings including the May meeting and earned at least five thespian points.Running for Office1. Must be a member enrolled in a Navo Theatre course during the year of office.3. Must have attended FIVE Navo Theatre meetings, including the May Navo Theatre meeting.4. Must attend officer candidate orientation prior to running for office at which theOfficer Constitution will be dispersed as well as all requirements
T. SOCIAL MEDIA PRESENSE
1. Any and all post or information, about or referring to The NAVO Theatre Department MUST comply with the DISD online guidelines.
2. Remember that if you are in this department you represent it both on and off of social media. If there are any infraction of the DISD online guidelines, the student will be removed from the production and department.
3. Navo Theatre Department has a Zero Tolerance Policy for online bullying, negativity and inappropriate material. It shall be up to the director and current school administration to define all the stated above. Infractions will result in removal from the production and school consequences.
Appendix 1Infractions and Consequences
The goal of Navo Theatre is to provide a quality experience in all areas of performance education. All students involved are expected to follow all rules and procedures outlined by the Handbook of Policies and Procedures, without exception. In the event of a violation of the rules, the Directors will use the following guide to determine the appropriate measures of discipline. These rules are in place to ensure the safety and success of all students involved in the program. Failure to fulfill the consequences given for an infraction will result in an additional, higher level consequence.
Infractions such as, but not limited to:
Examples of Consequences for each level can include, but are not limited to:
Level A Tardiness Jumping off stage / walking
on lip Food in unauthorized areas Leaving trash out Leaving tools out Inappropriate attire at
rehearsals Dressing room infractions Being in an unauthorized
area
Physical activities (i.e. laps around auditorium)
Cleaning duty of drama area Cleaning duty of paint buckets and
brushes Sweeping stage General theatre tasks Fines Loss or reduction of Thespian points
for activity during which infraction
Failure to turn in points sheet on time
Inappropriate language
occurs
Level B Breaking curtain Failure to fulfill
commitments Being seen by public in
costume and make-up Public Displays of affections
as defined in the NMS Student Code of Conduct
Eating in Costume Not obeying the 1½ hour of
mandatory focus time prior to a performance
Unprepared to perform assigned role in rehearsal/performance
Cell phones at rehearsal/performance
Lack of professionalism Graffiti Engaging in any activity that
could be perceived as diminishing to the integrity of the Navo Theatre
Sharing of food, drinks, or make-up
Multiple or severe infractions of Level A
Multiple Level A consequences Further loss or reduction of Thespian
points for activity during which the infraction occurs
One-on-one conference with student
Level C Being in opposite sex dressing room at unauthorized time
Disrespect to the Navo Theatre, its members, Directors, or audience
Being unprepared for assigned role or duty at rehearsal or performance
Multiple or severe infractions of Levels A and/or B
Multiple consequences of Levels A and/or B
Conference with parents and/or students.
Probation from the Navo Theatre Notification to NMS administration Greater loss or reduction of Thespian
points for activity during which infraction occurs.
Possible ineligibility to be cast in future productions
Level D Unexcused absence from Multiple consequences of Levels A,
rehearsal or performance Ineligibility Theft of departmental
property. Extreme disrespect to the
Navo Theatre, its members, Directors, or audience
Physical aggression Violation of the DISD drug
policy Multiple or severe
infractions of Levels A, B, and/or C
Indecent exposure
B, and/or C Removal from production District action Police action Greater or total loss of Thespian
points for activity during which infraction occurs
Ineligibility to be cast in future productions
PRINT Student’s Name
The 2018-2019 NAVO MIDDLE SCHOOL
Student/Parent Commitment
I understand the rules and expectations set forth by the NAVO MS Theatre Department Manual of Policies and Procedures vital to the safety and success of all students involved in the Navo Theatre.
I also understand that the directors reserve the right to amend or revise this document in order to ensure the safety of each student and the standards and practices of the department.
I have read and reviewed the Manual of Policies and Procedures in its entirety. By signing this document, I understand violation of these rules may result in disciplinary action.
Student Signature___________________________________________Date_______________
Parent/Guardian Signature___________________________________Date_______________
Right to Publish/Promote Disclaimer
I consent to the use of my name, photograph, and likeness in connection with articles and web page content, media, and multi-media that may be considered for publication on the Lewisville Independent School District. I also consent to the use of the names, photographs, and likenesses of those minor children, dependents, and/or wards for which I am authorized to give this consent. I understand that I am not being paid a fee, and I waive and release any claims I may have in connection with publication of said names, photographs, and likenesses, including without limitation, any claim for defamation, invasion of privacy, or commercial appropriation. Any photographs or articles will remain the copyrighted property of the Lewisville Independent School District.
Parent/ Guardian’s Signature _____ Date
This form and all signatures must be turned into the Vice President by callbacks or crews. If the student is unable to do so, they will be ineligible for participation in the production.
2018-2019 Health Release Form
Dear Parent/Guardian:
Your student has the opportunity to participate in a production with the NAVO MIDDLE SCHOOL THEATRE. In order to do so, this form must be completed, signed, and on file. Student Name (Print) Grade
Date of Birth _________ School ID #________
Home Phone # Cell Phone #_______________ Student Email Address ________________
Father/Stepfather Work# Second#
Email Address 1 Email Address 2________________________________
Mother/Stepmother Work# Second#
Email Address 1 Email Address 2________________________________
Alternate Emergency Contact: Phone# Relation
Student Home Address
Medical Information about student:
Insurance Provider Policy Number
Existing condition(s)
Allergies
Medication(s) taken routinely
I, the undersigned, do hereby authorize officials of the Denton I.S.D. to contact persons on this sheet in the event of illness, injury, and/or inappropriate behavior of my child. If I, or persons named on this sheet, cannot be reached, D.I.S.D school officials are hereby authorized to take whatever action is deemed necessary in their judgment, for the health and safety of said child. I realize that this form does not abrogate or modify my rights as a parent/guardian or a minor. I have voluntarily signed this form to facilitate and expedite the treatment of my child. I will not hold the D.I.S.D. or the school official(s) financially responsible for the emergency car and/or transportation of said child.
Signature Date
