I hereby agree to release and hold the Luther-Burbank High School, the Sacramento City Unified School District, its employees, and volunteer sponsors harmless from any and all liability and responsibility in connection with an accident and/or injury to my child as a result of disobedience to the policies found in this book while with the band on any official function or trip and any and all claims arising from injury or damage suffered or incurred by my child as a result of the acts, omissions, or conduct of any person other than the negligence of said District and personnel.  Should a medical emergency arise, I grant the school officials or volunteer sponsor permission to seek professional medical care for my child and I agree that I will be financially responsible for all charges/fees incurred in the rendering of said medical care.

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(Legal Guardian Signature)           (Date)

Email address: ___________________________

Phone: _________________________________

Emergency Contact: ______________________

Emergency Phone: ________________________