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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