Syllabus Agreement Form Page 4

Syllabus Agreement Form

I have read, understand and agree to follow the course syllabus requirements for the Scott

Memorial Middle School Band.

Student Name (Print)

Grade

Address

City\Zip

Parent or Guardian (Print)

Home Phone

Work Phone

Parent Email

Student Email

Student Signature

Date

As the legal guardian or custodial parent, I grant the George Wythe High School\Scott Memorial Middle

School Music Department permission to use my child’s photo and first name on their Web site for the

purpose of illustrating typical activities of a club, organization or educational activity.

__________________________________________

______________________

Parent\Guardian Signature

Date

George Wythe High School • Home of the Mighty Maroon Marching Band • Scott Memorial Middle School

The Pride of Virginia’s Mountain Empire

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