Hershey Elementary Instrument Ensemble Sign-ups
This form is the official sign-up to play an instrument at Hershey Elementary School. Please only fill out this form after viewing the parent night presentation. One form per 4th or 5th grade beginner student.
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Student First Name
Student Last Name
Student's Grade Level
Dunlop - 49
Edwards - 42
Gardner - 41
Gehman - 50
Mark - 40
Katerman - 51
Prestidge - 45
Querry - 43
Siminitus - 47
Coleman - 61
Hicks - 55
Miller - 62
Patrick - 65
Slater - 57
Stahl - 53
Termin - 56
Umberger - 63
Westervelt - 58
Williams - 59
Student's Instrument Choice
How are you obtaining an instrument?
renting/purchasing from Menchey's Music (band & orchestra)
Renting or purchasing from J.R. Judd Violins (orchestra)
Already own our instrument
If you answered 'other' above, please specify where you are obtaining your instrument.
Parent/Guardian #1 Name
Parent/Guardian #1 E-mail Address
Parent/Guardian #1 Phone Number
Parent/Guardian #2 Name
Parent/Guardian #2 E-mail Address
Parent/Guardian #2 Phone Number
Is there another adult that you would like to have added to out contact list? Please list their name, contact information, and relation to student below.
A copy of your responses will be emailed to the address you provided.
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This form was created inside of Derry Township School District.