2016 Jazz All Stars- Harrisburg Attendance Form

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Student Name: *

Instrument *

Grade *

4th

5th

6th

8th

7th

School: *

Emergency Contact Phone #: *

Emergency Contact *

Allergies or Medical conditions to be aware of? *

This is a backup to the medical form filled out at beginning of jazz band!

Will a parent or parents like to ride on the bus as chaperones? *

Yes

If Yes... Chaperone Names:

If yes to being a chaperone HOW MANY *

I will dive seperate and meet the bus in Harrisburg

Bus only holds 42 people

Yes

Clear selection

I will be at Archbishop Carroll BEFORE 9am *

Yes

If I arrive after 9am I understand that the bus will have left and will drive my child to Harrisburg *

Yes

Mr. Myers Contact Info

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