Band Interest Form 21-22

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This form is an annual survey to be completed at the beginning of the school year. Make sure you have your instrument and all of the accessories for it available and have located the serial number.

Welcome to the SSES Band Program

Name *

Address (in the following format) House #, Street Name, City, State, Zip Code *

Parents Name(s) *

Parents E-mail addresses *

Parents Phone Number ex.) 123-456-7890 *

What brings you to us today?

I registered for the class because I am interested in learning how to play a musical instrument

I registered for the class to continue playing a musical instrument

I didn't register for the class but am will to try

I didn't register for the class and not sure how I got here

Clear selection

Primary Instrument (The instrument you play the best or the instrument you would like to play) *

Do you have your own personal instrument? *

Instrument Serial Number (Ask for help locating this) *

Instrument Make and Model (the name should be found on the instrument somewhere or the case) ex. Bach, Yamaha, Selmer-Bundy *

If you currently have a school instrument, check all the items you currently have with that instrument.

Mouthpiece

Mouth Cap

Ligature

Neck Strap

Sousaphone Neck

Sousaphone Tuning Bits

Instrument Case

Swab (Flute, Clarinet, Saxophone)

Drum Sticks

Mallets

Band Accessories

Percussion Accessories

Your current level of experience playing an instrument. *

Zero Years Experience

1 Year Experience

2-3 Years Experience

Not consistently (only for a quarter, semester, or with some years off of the instrument

Have you ever had a music class during the school day? *

Yes

Have you taken private lessons on your instrument? *

Yes, currently taking lessons.

Yes, but in the past.

Previous School Year or previous quarter G.P.A. (Grade Point Average) *

Can you read sheet music? *

Yes, very well

Yes, but I have some weak areas

No, but I play by ear.

Not at all.

Do you currently belong to any other extracurricular activities? List all of the activities below. *

List any rewards or achievements you have received in school or your community. *

What do you expect to learn this year in my class? *

Submit

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