UVA Wise Summer Band Conservatory
Event Timing: July 11-15; 1 - 5 p.m.
Location:  Gilliam Center For the Arts
Contact Richard Galyean at:  rdg3y@uvawise.edu
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Name *
Email *
Instrument *
Student Grade This Upcoming Year *
Parent or Guardian Names *
Parent or Guardian Cell Phone Numbers (please list at least two in the event of emergency) *
Mailing Address *
I understand that I must provide my own band instrument.  Percussionists must bring a set of snare sticks and mallets. *
Medical Information:  Please list anything we may need to know in order to take care of your child such as whether or not they have allergies, asthma and an inhaler, etc.  Let us know how you would like for us to handle any medical emergency. *
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