2017 Middle School Summer Band Registration Form
Middle School Band registrations are accepted up to the date your session begins, July 10, 2017.

Please note: The grade levels listed for the class options are the grade the student WILL ENTER in the Fall of 2017.

There will be NO CONFIRMATION of enrollment notices for MMS band registrations. Completion of this application ensures your placement in the class.

Your instrument must be assigned by Mr. Fuller prior to registration.

Student's Last Name *
Your answer
Student's First Name *
Your answer
Student's Current Grade *
Required
If student is currently in 5th grade, please indicate the 5th grade teacher's name.
Your answer
Student's School *
Required
Parent/Guardian Name *
Your answer
Parent/Guardian Address *
Your answer
Email address *
Your answer
Home Phone (xxx) xxx-xxxx *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact's relationship to student *
Your answer
Emergency Contact's phone (xxx) xxx-xxxx *
Your answer
Please indicate your choice below. All classes run July 10 through 21, Monday through Friday (10 days). *
Required
Please indicate the instrument you will play in Middle School Summer Band. (Your instrument must be assigned by Mr. Fuller prior to registration.) *
Required
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