The Brigadiers'
New Horn
Sponsor Program

Help Support The Brigadiers

Sponsored By:











City of Syracuse,
Dept. of Parks, Recreation, and
Youth Programs

Membership Application

Last Name:*
First Name:*
Nickname:
Section Interested In:*
Date of Birth (yyyy-mm-dd):*
Street Address:*
City:*
State:*
Zip Code:*
Country:*
Home Phone:*
Work or School Phone:
Cell Phone:*
Email Address:*
Personal Website:
Student Status:
School Name:
 
FATHER'S INFORMATION: (Required if under 18)
Last Name:
First Name:
Street Address:
City:
State:
Zip Code:
Country:
Occupation:
Home Phone:
Work or School Phone:
Cell Phone:
Email Address:
Would he be interested in volunteering? Yes    No
 
MOTHER'S INFORMATION (Required if under 18)
Last Name:
First Name:
Street Address:
City:
State:
Zip Code:
Country:
Occupation:
Home Phone:
Work or School Phone:
Cell Phone:
Email Address:
Would she be interested in volunteering? Yes    No

Please list the Corps or Bands marched with and dates:*

Do you owe any other corps money, equipment or uniforms?*
No    Yes    If yes, please explain below.

BRIGADIERS MEDICAL INFORMATION
(All Information is Required)

Who should we contact in case of emergency?
Name:
Relation to you:
Phone Number:
Medical Insurance Company:
Insurance through: Father     Mother     Self
Family Physician:
Physician Phone Number:
Physician Address:
Physician City:
Allergies:
Medication:
Reason for Medication:

Do you or did you ever have?

  Yes No
Diabetes
Epilepsy
Asthma
Migraine Headaches
Bleeding Disorder
Breathing Disorder
Heart Conditions
Arthritis
Knee or Ankle Problems
Back Problems
Carpal Tunnel Syndrome
Wear Glasses/Contacts

If you answered YES to any of the above, please explain:

  Yes No   Explanation
Any Fractures? Location & Date
Any Surgeries? Reason & Date

Have you had or been vaccinated for:

  Yes No
Measles
Chicken Pox

Date of last Tetanus Shot:
(If it has been more than 5 years, we suggest that you get a booster shot before tour.)

PLEASE UNDERSTAND THAT YOU WILL STILL HAVE TO PERSONALLY SIGN THE PAPERWORK AT THE FIRST CAMP. THIS COMPLETED FORM WILL BE ATTACHED TO YOUR SIGNED PAPERWORK.

MEMBERS UNDER THE AGE OF 18 MUST HAVE THEIR PARENT OR GUARDIAN SIGN.
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