Summer Music Registration 2019
Please complete this form to register for the summer music program. Registration will be complete with a successful payment through EZSchoolPay (
) or the submission of a check to Mr. Jordan's attention at the Ed Center.
City, State, Zip Code
Home Phone Number
Parent/Guardian Work Phone
Emergency Contact during summer program (name & contact number)
School Attending during 2019-2020 school year
For which program are you registering?
Elementary Band (rising 5th grade band members)
Elementary Orchestra (rising 4th, 5th, and 6th grade orchestra members)
Elementary Band & Orchestra
Middle School Band (rising 6th, 7th, and 8th grade band members)
Secondary Orchestra (rising 7th-12th grade orchestra members)
Middle School Band & Secondary Orchestra
Send me a copy of my responses.
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This form was created inside of Boyertown Area School District.