REGISTER FOR THE Fall 2016 BAND PROGRAM

Parent(s) Name *
Parent(s) Name
Primary Phone
Primary Phone
Student's Name *
Student's Name
Student Birthdate
Student Birthdate
Student's Instrument of Interest
Check all that apply
Please indicate if the student is signing up with friends or siblings, and their names. Otherwise, leave blank.
If there is a strong preference for band practice (e.g. Mondays at 8pm), we will do our best to accommodate it, on a first-come, first-serve basis. We recommend listing a few options.
We don't want to schedule band practice that conflicts with soccer practice. Please list any days and times when the student is already engaged on a weekly basis.
Only those that could be encountered at the Rock Stop.
Emergency Contact
Emergency Contact
Only used in the event the parent(s) are not reachable.
Phone Number
Phone Number
Is there anything else we should know about?
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