Northgate Marching Band 2024
Please fill out this registration form and pay the requested MBA tax-deductible contribution of $450 through nimbconnect.org by May 31, 2024.   There, you can choose to set up a payment plan, or pay in full at the time of registration.

If you prefer to pay by check, it can be made payable to NIMB with "MBA (Student Name)" in the memo line. If paying by check please drop in the Red Drop Box in Northgate's Band Room before May 31, 2024, OR mail to:

NIMB
P.O. Box 30232
Walnut Creek, CA 94598

Please complete a Registration for each student individually (if you have two students registering, complete this form twice).
Sign in to Google to save your progress. Learn more
Student's Full Name *
Student Prefers to be called.
Grade in August 2024 *
Instrument Played *
Student's Cell Phone Number *
Student's Email *
Student's Primary Address *
Parent's/Guardian's Full Name Primary *
Parents/Guardian's Cell Phone Primary *
Parent/Guardian's Email Address *
Parents/Guardian's Address Primary *
Parent's/Guardian's Full Name Secondary
Parent's/Guardian's Cell Phone Secondary
Parent/Guardian's Email Secondary
Parent's/Guardian's Address Secondary
Emergency Contact's Full Name & Number *
Please list all known allergies or N/A if none *
Is your student on any medication? *
If "Yes" names of medications and times to be taken
Does your student carry any doctor prescribed medications? *
If "Yes" what is the name of the medication and when do, they need to take it?
Does your student have any medical conditions that we should know about? If yes describe *
Name of Medical Provider *
Insurance Carrier *
Medical Number/Policy Number *
Medical Providers Phone Number *
Will your student miss any days of Band Camp? If yes which days *
Tax Deductible Donation $450 has been paid (or payments have been set up) through the store on NIMBconnect.org.
*
Please read the following Code of Conduct agreement thoroughly.  After you and your student have read the agreement, please type both student and parent/guardian names below to indicate your acceptance of the terms outlined in the agreement.
*
Please read the following Publishing Release agreement thoroughly. After you have read the agreement, please type parent/guardian name below to indicate your acceptance of the terms outlined in the agreement.
*
Please DOWNLOAD the following documents: 
1. Instrumental Music Transportation Parent Permission Form, and

Please complete the two forms (ideally digitally), then print and manually sign. Please either email signed forms to Parent Coordinator, Adri Hogg at hoggfamily2-3@att.net, or drop in the Red Drop Box in Northgate's Band Room before May 31, 2024 OR hand deliver to Parent Coordinator Adri Hogg on the first day of Band Camp.

Keep the 2024 MBA Info Flyer for your information.

I have downloaded the Instrumental Music Transportation Parent Permission Form and the Medical Release Form, and I will return them to the Parent Coordinator:
*
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy