MPLT 2020 - 2021 Information Verification Form
In an effort to keep our records accurate and ensure that you receive timely communications, please complete all applicable sections of this form. All required fields are marked with a red star.
Email address *
STUDENT INFORMATION
Student's Last Name *
Student's First Name *
Note: This should be the student's legal name; if a student has another name they prefer to go by, please provide it in the next section.
Student's Preferred Name
Graduation Year *
School - Fall of 2020 *
Men's T-Shirt Size *
Marching Band Instrument *
Dietary Restrictions
Mailing Address: Street/City/Zip *
e.g. 12345 Anywhere Street
Home Phone/Primary Phone Number *
Please provide us with the best phone number (with area code) to reach you, and indicate whether the number is a cell or home number. (e.g. Cell: 999-123-4567)
Does the student have a smartphone? *
PARENT/GUARDIAN INFORMATION
Parent/Guardian #1 *
Parent/Guardian #1 Relationship to Student *
Parent/Guardian #1 Cell Phone or Primary Phone Number *
Please provide us with the best phone number (with area code) to reach you, and indicate whether the number is a cell or home number. (e.g. Cell: 999-123-4567)
Parent/Guardian #1 Work Phone Number
Please include the area code and extension, if applicable.
Parent/Guardian #1 Email Address *
Parent/Guardian #2
Parent/Guardian #2 Relationship to Student
Parent/Guardian #2 Cell Phone or Primary Phone Number
Please provide us with the best phone number (with area code) to reach you, and indicate whether the number is a cell or home number. (e.g. Home: 999-123-4567)
Parent/Guardian #2 Work Phone
Please include the area code and extension, if applicable.
Parent/Guardian #2 Email Address
EMERGENCY CONTACT INFORMATION
Please provide at least one individual that MPLT staff can contact in the event of an emergency. Note: This should be someone other than a parent or guardian.
Emergency Contact #1 *
Emergency Contact #1 Phone Number(s) *
Please provide at least one phone number with area code, and indicate whether the number is work, cell, home, etc. (e.g. Cell: 999-123-4567; Home: 999-321-7654)
Emergency Contact #1 Relationship to Student *
Emergency Contact #2
Emergency Contact #2 Phone Number(s)
Please provide at least one phone number with area code, and indicate whether the number is work, cell, home, etc. (e.g. Cell: 999-123-4567; Home: 999-321-7654)
Emergency Contact #2 Relationship to Student
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