Student Information Form 2018-2019
INSTRUCTIONS:
1. 7th and 8th grade parents: be sure to have your child's instrument serial number handy before beginning.
(Percussionists do not need this.)
2. If you have a Harris Teeter VIC number, please have it available as well.
3. Be sure you enter email address accurately, as our contact list comes directly from the responses on this form.
Student LAST Name *
Your answer
Student FIRST Name *
(or name he/she is called by teachers)
Your answer
Grade
Street Address
(number and street name)
Your answer
City
Your answer
Zip Code
5-digits only
Your answer
Home Phone (XXX-XXX-XXXX) *
Land line only. If no land line, use a preferred parent cell number please.
Your answer
Instrument *
BEGINNERS MAY ONLY SELECT FLUTE, CLARINET, TRUMPET, OR TROMBONE.
Instrument Brand Name
Beginners: skip this response. Percussionists: skip this response.
Your answer
Instrument Serial Number
Beginners: skip this response. Percussionists: skip this response.
Your answer
Mother's LAST Name
Your answer
Mother's FIRST Name
Your answer
Mother's CELL Phone (XXX-XXX-XXXX)
Your answer
Mother's Employer *
This information may be used in seeking corporate donations for our band booster organization. If not employed, please enter"none."
Your answer
Mother's WORK Phone (XXX-XXX-XXXX)
Your answer
Mother's Harris Teeter VIC Card Number
This will link your VIC account to our band booster organization so that when you shop, a portion of your bill will be used to support our band program.
Your answer
Father's LAST Name
Your answer
Father's FIRST Name
Your answer
Father's CELL Phone (XXX-XXX-XXXX)
Your answer
Father's Employer *
This information may be used in seeking corporate donations for our band booster organization. If not employed, please enter"none."
Your answer
Father's WORK Phone (XXX-XXX-XXXX)
Your answer
Father's Harris Teeter VIC Card Number
This will link your VIC account to our band booster organization so that when you shop, a portion of your bill will be used to support our band program.
Your answer
Parent Email Address #1 *
Your answer
Parent Email Address #2
Complete if more than one parent wishes to receive band updates via email.
Your answer
Submit
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