5th Grade Orchestra Enrollment Form
Please fill out this form to enroll your student in 5th grade orchestra. If you have any questions regarding enrollment or class, please contact your school’s strings teacher. Classes begin the week of 9/4/17 (after Labor Day)
Rebecca Doss (Epic, SC, LC, LS, RV): rebecca.doss@lps53.org
Elizabeth Anderson (WH, AD, FR, KB, MH): elizabeth.anderson@lps53.org
Marie Coleman (LO): marie.coleman@lps53.org
Student First Name
Your answer
Student Last Name
Your answer
Student School
What instrument will your child play?
Please select one.
Classroom Teacher Last Name
Your answer
Parent/Guardian Last Name
Your answer
Parent/Guardian First Name
Your answer
Parent/Guardian Contact email
Your answer
Additional contact email
Your answer
Parent/Guardian Contact Phone Number #1
Example: (XXX) XXX-XXXX
Your answer
Parent/Guardian Contact Phone Number #2
Example: (XXX) XXX-XXXX
Your answer
Emergency Contact Person
First Name, Last Name, Relationship to Student
Your answer
Emergency Contact Person Phone Number
Example: (XXX)XXX-XXXX
Your answer
$15 fee includes a t-shirt & entry to Fiddlin' in February and may be paid by check or online with a credit card. https://liberty.revtrak.net/Elementary-Schools-47#/list DUE: Monday, Sept. 11
T- Shirt Size (Adult Sizes)
Any health concerns that should be noted?
Your answer
I understand that my child will need to be picked up/dropped off at the times indicated for their school. If I am unable to, I will have a a system in place for an alternative ride.
We will contact your emergency contact in order to ensure your child will arrive home safely and in a timely manner.
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