5th Grade Orchestra Registration 2022-2023
Please fill out this form to sign your student up for orchestra. If you have any questions regarding enrollment or class, please contact your school’s orchestra teacher.  Class start TBA 2022-2023.
Rebecca Doss (EPiC, LC, LO, RV, SC): rebecca.doss@lps53.org
Kayl Soukup (LS): kayl.soukup@lps53.org
Savana Ritter (AD, FR, KB, MH, WH): savana.ritter@lps53.org
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Email *
STUDENT First Name *
STUDENT Last Name *
Student School *
What instrument will your child play? *
Please select one. *CELLOS CANNOT BE TAKEN ON THE BUS
5th Grade Classroom Teacher Last Name *
If known - otherwise mark TBD (to be determined)
Parent/Guardian First Name *
Parent/Guardian Last Name *
Parent/Guardian Preferred Contact email *
Additional Contact Email
Parent/Guardian Preferred Contact Phone Number #1 *
Example: (XXX) XXX-XXXX
Parent/Guardian Contact Phone Number #2 *
Example: (XXX) XXX-XXXX
Emergency Contact Person *
First Name, Last Name, Relationship to Student
Emergency Contact Person Phone Number *
Example: (XXX)XXX-XXXX
Concert T- Shirt Size *
Required
Any health concerns or information that should be noted?   *
If you do not feel comfortable sharing health concerns, please email your orchestra teacher.
Required
I understand that my child will need to be picked up/dropped off at the times indicated for their school. If I am unable to, I will have a a system in place for an alternative ride. *
We will contact your emergency contact in order to ensure your child will arrive home safely and in a timely manner.
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