2016 P1 Texans Application - Percussion One Foundation

Percussion One:
Percussion One:
THE DRUMLINE/THE ENSEMBLE
THE DRUMLINE/THE ENSEMBLE
is a non-profit 501(c)(3) independent,
community based drumline and
percussion ensemble comprised of
high school percussionists from the
Greater Houston area.
performance group was created to
give young players from varying
backgrounds and programs an
opportunity to perform in a drumline
and percussion ensemble that
provides excellence in percussive
arts education and stresses an
exemplary standard of citizenship.
2016 NFL Houston Texans Performance
Season:
Houston’s Premier
Drumline/Ensemble
September 11, 2016 –
December 18, 2016
Lamar Burkhalter
Founder/Executive Director
Includes:
• Instruction with some of the most
reputable percussion instructors in
Houston
• 4 Texans Pregame Performances
• T-Shirts provided by the NFL
Houston Texans
• Possible playoff pregame
performances
Percussion One –
NFL Houston Texans
Performance Season
Each Percussionist will be required to:
• Submit Band or Percussion
Director Recommendation Form
by August 21st
• Sign the Performance Agreement
• Attend all rehearsals and
performances
• Provide Khaki Shorts and
Required Footwear
Registration & Rehearsal:
Rehearsal & Registration for P1/Texans will
take place at NRG Stadium on:
Sunday, August 21th
1:00 pm – 4:00 pm
Pre-register by email:
Send Name, Age, Grade, School, and
marching instrument (snare, tenors, bass,
cymbals) to:
[email protected]
Performance Dates:
• Sunday, September 11th
8:00 am Arrival
• Sunday, October 16th
3:30 pm Arrival
• Sunday, November 27th
8:00 am Arrival
• Sunday, December 18th
8:00 am Arrival
• Possible Playoff Games
100% attendance required for all
rehearsals and performance!
Come Play for the
NFL Houston Texans!!!
Registration & Rehearsal:
Sunday, August 21st
Registration: 1:00 pm
Rehearsal: 1:00 – 4:00 pm
at NRG Stadium
Parking Directions at NRG Stadium
for Registration & Rehearsal on
st:
Sunday, August 21
• Red Lot at the Corner of
McNee & Kirby
• Tell Security you are with
Percussion One
• Meet at the Guard Shack at
the entrance to the loading
dock across the street from
the Red Lot
P1/Texans will form 4 drumlines to
perform at all 4 NRG Stadium Gates
prior to designated NFL Houston Texans
games.
Drumline Instrumentation for each gate:
• 8 – 10 Snares
• 4 – 6 Tenors
• 8 – 10 Bass Drums
• 4 – 8 Cymbals
Admission:
Admission into the group will be based on
the Recommendation Form from your Band
or Percussion Director and an interview
with Lamar Burkhalter.
Performances:
P1 Texans Group will consist of 4 complete
drum lines that will perform at all 4 entry
gates to NRG Stadium for the 4 pregame
performances.
No Membership Fee:
There is no membership fee for the NFL
Houston Texans Performance Season
2016.
Uniform Requirements:
All P1/Texans members will be provided
with P1/Texans t-shirts to wear for
performances. Members will be required to
provide their own khaki shorts and plain
white lace-up tennis shoes and white
socks.
Membership Forms are posted at:
www.percussionone.org
Completed Membership Forms including
the Band Director Recommendation Form
must be submitted on or before August
21st to be accepted into the program.
Please contact Mr. Burkhalter via email at
[email protected]
with any questions or concerns.
Percussion One
281-773-7381
Mr. Lamar Burkhalter, Founder and Executive
Director of Percussion One, currently serves as
the Music Director for the NFL Houston Texans.
Mr. Burkhalter is endorsed by the Yamaha
Corporation of America, the Latin Percussion
Music Group, Evans Drumheads, Zildjian
Cymbals, and Vic Firth.
Please visit the Percussion One website for
a complete bio.
www.percussionone.org
PERCUSSION ONE – NFL HOUSTON TEXANS SEASON 2016
MEMBER/PARENT INFORMATION
Please Print Clearly
Date: _______________
Group: P1/Texans East____ P1/Texans____
P1/Texans East includes students from New Caney, ISD, Humble ISD, Conroe ISD, Willis ISD, and Splendora ISD.
P1 Texans includes students from all other districts.
Member’s First Name:
Member’s Last Name:
Member’s Home Phone:
Member’s Cell Phone:
Member’s E-mail Address:
School member attends:
Age:
Grade Level:
Date of Birth:
Street Address:
City:
State:
Parent’s Home Phone:
Zip Code:
Fax Number:
Father’s Name:
Father’s Work Phone:
Father’s Cell Phone:
*E-mail Address:
Mother’s Name:
Mother’s Work Phone:
Mother’s Cell Phone:
*E-mail Address:
*Other E-mail Address:
Will you, the parents, help provide transportation and chaperone events?
Member’s T-shirt Size (adult sizes only):
*Percussion One communicates to students and parents via e-mail. Please include only the e-mail addresses in
which you would like to receive Percussion One correspondence. It is important that we have at least one email
address for each member and one parent email address.
PERCUSSION ONE
Membership & Performance Agreement
Mission Statement
It is the goal of PERCUSSION ONE to provide a setting for the percussive arts that stresses excellence in education
and performance.
This agreement applies to all activities of PERCUSSION ONE for the NFL Houston Texans Performance Season
2016-2017.
Student’s Name: __________________________________________________________
Welcome to PERCUSSION ONE. We are happy to have you as a member of one of the finest percussion ensembles in the country.
PERCUSSION ONE is an elite group that represents excellence in both percussion performance and citizenship. In order to continue this
excellence, all members must agree to the following guidelines:
Participation in all rehearsals and performances is required. If you cannot commit to 100% participation, you do not qualify
to be a member of the group. Illness or a family emergency will be considered as an excused absence and a parent needs to
contact Mr. Burkhalter directly at 281-773-7381 to inform him of the absence.
Please also plan to arrive 15 to 20 minutes prior to rehearsal to allow time to set up instruments. In addition, it is necessary
that all members have the prescribed and assigned music learned through independent practice prior to the
rehearsal/performance.
Percussion One stresses citizenship and respect and expects all members to be on their best behavior at all times, showing
respect to the entire staff of Percussion One, fellow members and audiences as well as their rehearsal and performance
facilities.
The Percussion One Foundation Board of Directors and Officers makes all decisions regarding music, assignments, fees,
guidelines and personnel. In addition, it is understood that PERCUSSION ONE FOUNDATION, Mr. Burkhalter, the PERCUSSION
ONE staff or PERCUSSION ONE volunteers, will not assume any responsibility in case of accident, injury, or other loss
associated with PERCUSSION ONE and its activities.
____________________________________________
Student’s signature
_______________________________
Date
____________________________________________
Parent’s or Guardian’s signature
_______________________________
Date
____________________________________________
Parent’s or Guardian’s signature
_______________________________
Date
PERCUSSION ONE FOUNDATION
PARENTAL CONSENT,
AFFIRMATION, LIABILITY RELEASE AND INDEMNITY AGREEMENT
This document is to be executed by the parents or legal guardian of any person who is less than 18 years of age and who
will be participating in Percussion One Foundation’s activities during the NFL Houston Texans Season 2016, and could
include playoff game performances in 2017.
Read carefully before affixing your signature.
State of Texas, County of Harris
____________________________ (name of parents or legal guardians), the parents or legal guardians of
___________________ (name of minor), a minor, enter into this agreement for the purpose of, and in consideration for,
enabling ______ (him or her) to participate in Percussion One Foundation’s activities. ____________________________
(name of parents or legal guardians) hereby agree and state as follows:
1) I HEREBY PERSONALLY ASSUME ALL RISK IN CONNECTION WITH ______________'S (name of minor)
PARTICIPATION IN PERCUSSION ONE FOUNDATION’S ACTIVITIES, INCLUDING ANY RISK OF HARM, DEATH,
BODILY OR OTHER INJURY, OR DAMAGE THAT MAY BEFALL HIM/HER OR HIS/HER PROPERTY AS A RESULT OF
HIS/HER PARTICIPATION IN PERCUSSION ONE FOUNDATION’S ACTIVITIES, WHETHER FORESEEN OR
UNFORESEEN, AND I AUTHORIZE HIM/HER TO PROCEED WITH PARTICIPATING IN SUCH ACTIVITIES IN SPITE
OF THE RISKS. I AND _____________ (name of minor), TOGETHER WITH ALL OF OUR HEIRS, EXECUTORS,
ADMINISTRATORS, ASSIGNS, AND FAMILY MEMBERS, HEREBY COMPLETELY RELEASE, WAIVE AND FOREVER
DISCHARGE FROM ANY AND ALL LIABILITY PERCUSSION ONE FOUNDATION, AND ITS PAST, PRESENT AND
FUTURE SUCCESSORS, ASSIGNS, OFFICERS, DIRECTORS, AGENTS, REPRESENTATIVES, AND EMPLOYEES,
INCLUDING BUT NOT LIMITED TO LAMAR BURKHALTER, OF AND FROM ANY AND ALL LOSSES, CLAIMS,
LIABILITIES, DEMANDS, COSTS, DAMAGES, OR CAUSES OF ACTION, WHETHER BASED ON A TORT OR ANY
OTHER THEORY OF RECOVERY, INCLUDING NEGLIGENCE, FOR PERSONAL INJURY, DEATH, PROPERTY
DAMAGE OR OTHER DAMAGES ARISING FROM ___________________'S (name of minor) PARTICIPATION IN
PERCUSSION ONE FOUNDATION’S ACTIVITIES. THIS RELEASE IS SPECIFICALLY INTENDED TO RELEASE
THOSE RELEASED HEREIN EVEN FROM THE CONSEQUENCES OF THEIR OWN NEGLIGENCE.
2) I AGREE TO INDEMNIFY AND HOLD HARMLESS PERCUSSION ONE FOUNDATION AND ITS
SUCCESSORS, ASSIGNS, OFFICERS, DIRECTORS, AGENTS, REPRESENTATIVES, AND EMPLOYEES,
INCLUDING BUT NOT LIMITED TO LAMAR BURKHALTER, FOR ANY LOSS, LIABILITY, CLAIM, DEMAND, COST,
DAMAGE OR CAUSE OF ACTION THEY MAY INCUR DUE TO _________________'S (name of minor)
PARTICIPATION IN PERCUSSION ONE FOUNDATION’S ACTIVITIES WHETHER CAUSED BY HIS/HER
NEGLIGENCE OR OTHERWISE.
3) I FURTHER STATE THAT I AM OF LAWFUL AGE AND LEGALLY COMPETENT TO SIGN THIS PARENTAL
CONSENT, AFFIRMATION, LIABILITY RELEASE, AND INDEMNITY AGREEMENT; THAT THIS PARENTAL
CONSENT, AFFIRMATION, LIABILITY RELEASE, AND INDEMNITY AGREEMENT CONTAINS THE ENTIRE
AGREEMENT BETWEEN THE PARTIES; THAT I UNDERSTAND THE TERMS HEREIN ARE CONTRACTUAL AND
NOT A MERE RECITAL; THAT I HAVE SIGNED THIS DOCUMENT OF MY OWN FREE WILL; AND THAT I HAVE
FULLY INFORMED MYSELF OF THE CONTENTS OF THIS DOCUMENT BY READING IT BEFORE I SIGNED IT.
4) I EXPRESSLY AGREE THAT THIS DOCUMENT IS INTENDED TO BE AS BROAD AND INCLUSIVE AS
PERMITTED BY THE LAWS OF THE STATE OF TEXAS AND THAT IF ANY PORTION HEREOF IS HELD INVALID, IT
IS AGREED THAT THE BALANCE SHALL CONTINUE IN FULL LEGAL FORCE AND EFFECT.
5) I EXPRESSLY AGREE THAT THIS DOCUMENT WILL BE CONSTRUED IN ACCORDANCE WITH AND
GOVERNED BY THE LAWS OF THE STATE OF TEXAS.
In witness whereof, I hereby execute this parental consent, affirmation, liability release and indemnity agreement at
_____________, Texas, on the ____ day of _____________, 20___.
______________________________________
(Signature of Parent or Guardian)
______________________________________
(Signature of Parent or Guardian)
______________________________________
(Print full name and relationship to minor)
______________________________________
(Print full name and relationship to minor)
Percussion One Emergency Contact and Medical Information
M F
Sex
Child’s Name
Date of Birth
Parent’s/Guardian’s Name
Parent’s/Guardian’s Name
Home Phone
Cell Phone
Work Phone
Home Phone
Cell Phone
Address
Address
City, ST ZIP Code
City, ST ZIP Code
Work Phone
Alternative Emergency Contacts
Primary Emergency Contact
Home Phone
Cell Phone
Secondary Emergency Contact
Work Phone
Home Phone
Cell Phone
Work Phone
Medical Information
Hospital/Clinic Preference
Physician’s Name
Phone Number
Insurance Company
Policy/Group Number
Insurance Company Phone Number
Parent/Guardian Employer
Allergies/Special Health Considerations
I authorize all Release
medical and surgical treatment, X-ray, laboratory, anesthesia, and other medical and/or hospital procedures as may be
Medical
performed or prescribed by the attending physician and/or paramedics for my child and waive my right to informed consent of
treatment. This waiver applies only in the event that neither parent/guardian can be reached in the case of an emergency.
Parent’s/Guardian’s Signature
Date
I hereby give myConsent
consent for the above student to participate in Percussion One Foundation approved activities. In addition, I give
Informed
my consent for the above student to travel with the Percussion One staff, parents and chaperones.
It is understood that even though directors stress good safety, the possibility of accidental or other physical injury still remains.
Neither Percussion One Foundation nor the Percussion One staff will be held responsible for any medical expense incurred by
students as a result of their participation in Percussion One Foundation sponsored activities.
If, in the judgment of any representative of Percussion One Foundation, the above student should need immediate care and
treatment as a result of injury or sickness, I do hereby request, authorize and consent to such care and treatment, as may be given
to said student by any physician, trainer, nurse, hospital, Percussion One representative, parent or chaperone; and I do hereby
agree to indemnify and save harmless Percussion One Foundation, any Percussion One representative, parent or chaperone from
any claim by any person whomsoever on account of such care and treatment of said student.
Parent’s/Guardian’s Signature
Date
Witness Signature
Date
Percussion One Foundation
Photograph & Video Release
I, __________________________(print member name) do hereby give Percussion One Foundation,
photographer, videographer, assigns, licensees, successors in interest, and legal representatives the
irrevocable right to use my name, picture, portrait, photograph, or video in all forms and in all media
and in all manners, without any restriction as to changes or alterations (including but not limited to
composite or distorted representations or derivative works made in any medium) for advertising,
trade, promotion, exhibition, or any other lawful purposes, and I waive any right to inspect or approve
the photograph(s), video(s), or finished version(s) incorporating the photograph(s) or video(s),
including written copy that may be created and appear in connection therewith.
I hereby release and agree to hold harmless Percussion One Foundation, photographer,
videographer, assigns, licensees, successors in interest, legal representatives and heirs from any
liability by virtue of any blurring, distortion, alteration, optical illusion, or use in composite form
whether intentional or otherwise, that may occur or be produced in the taking of the photographs or
videos, or in any processing tending toward the completion of the finished product, unless it can be
shown that they and the publication thereof were maliciously caused, produced, and published solely
for the purpose of subjecting me to conspicuous ridicule, scandal, reproach, scorn, and indignity.
I agree that Percussion One Foundation owns the copyright in these photographs and videos, and I
hereby waive any claims I may have based on any usage of the photographs, videos, or works
derived there from, including but not limited to claims for either invasion of privacy or libel. I am of full
age* and competent to sign this release. I agree that this release shall be binding on me, my legal
representatives, heirs, and assigns. I have read this release and am fully familiar with its contents.
Signed: _________________________
Witness: ________________________
Member
Address: _________________________
Address: ________________________
Date: _________________, 20___
Date: _________________, 20___
___________________________ Consent (if applicable)__________________________
I am the parent or guardian of the minor named above and have the legal authority to execute the
above release. I approve the foregoing and waive any rights in the premises.
Signed: _________________________
Witness: ________________________
Parent or Guardian
Address: _________________________
Address: ________________________
Date: _________________, 20___
Date: _________________, 20___
* Delete this sentence if the subject is a minor. The parent or guardian must then sign the consent.
PERCUSSION ONE
Director/Instructor
Recommendation Form
This form is to be completed by your
Band Director or Percussion Instructor.
Dear Director/Instructor:
Please fax to 281-355-7668 or scan and e-mail to [email protected] the completed form to arrive
as soon as possible. Students will not be accepted into the program if this form is not received.
This serves as a recommendation letter for:
________________________________________________________
(Student’s Name)
Director/Instructor’s (Print Name): ___________________________Signature:__________________________
School: ________________________________Position: _______________________Phone:_______________
With “5” being the highest, and “1’ being the lowest, please circle the appropriate number as it applies to the
above named student.
Reliability
5
4
3
2
1
Accountability on music preparation
5
4
3
2
1
Ability to work with others
5
4
3
2
1
Receptiveness to criticism
5
4
3
2
1
Musical ability
5
4
3
2
1
Versatility on all percussion instruments
5
4
3
2
1
Parental support (if known)
5
4
3
2
1
Comments: (strengths/weaknesses, overall opinion)
__________________________________________________________________________________________
__________________________________________________________________________________________