Contacts & details
For WHSS Music Program families
Student 1 First Name
Your answer
Student 1 Last Name
Your answer
Music ensemble / choir
Required
Parent / Caregiver Name 1
Your answer
Parent / Caregiver Name 2 (if applicable)
Your answer
Email 1
Your answer
Email 2 (if applicable)
Your answer
Phone number 1
Your answer
Phone number 2
Your answer
Levy paid?
Required
Levy payment date
MM
/
DD
/
YYYY
Levy payment amount
Required
Payment reference (for direct deposit only)
Your answer
Another student to add?
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