Island Ukuleles Registration 2016/2017
September 2016 - June 2017 Registration
Student Name (1)
First and last name please
Your answer
What Group Is Your Student Registering For? (1)
A Group (Auditioned 8 - 12), B Group (grade 4 - 8), Spring Trial (grades 3 and up) beginning May 1
What Grade Is Your Student In For The 2016/17 School Year? (1)
What School Does Your Student Attend? (1)
Your answer
School District (1)
Please indicate the district number of your school
Medical Alert Information
Please indicate any allergies, medications, or existing medical conditions that we should be aware of?
Enter "N/A" in none exist
Your answer
Additional Family Registration
Island Ukuleles is very proudly a family based program and we encourage all eligible students in a family to be a part. If you have more than one student, please enter their information here. Family rates are applicable, please discuss with our secretary or treasurer.
Student Name (2)
First and last name please
Your answer
What Group Is Your Student Registering For? (2)
A Group (Auditioned 8 - 12), B Group (grade 4 - 8), Spring Trial (grades 3 and up) beginning May 1
What Grade Is Your Student In For The 2016/17 School Year? (2)
What School Does Your Student Attend? (2)
Your answer
School District (2)
Please indicate the district number of your school
Medical Alert Information
For Student 2
Please indicate any allergies, medications, or existing medical conditions that we should be aware of?
Enter "N/A" in none exist
Your answer
Additional Family Registration
Island Ukuleles is very proudly a family based program and we encourage all eligible students in a family to be a part. If you have more than one student, please enter their information here. Family rates are applicable, please discuss with our secretary or treasurer.
Student Name (3)
First and last name please
Your answer
What Group Is Your Student Registering For? (3)
A Group (Auditioned 8 - 12), B Group (grade 4 - 8), Spring Trial (grades 3 and up) Beginning May 1
What Grade Is Your Student In For The 2016/17 School Year? (3)
What School Does Your Student Attend? (3)
Your answer
School District (3)
Please indicate the district number of your school
Medical Alert Information
For Student 3
Please indicate any allergies, medications, or existing medical conditions that we should be aware of?
Enter "N/A" in none exist
Your answer
Primary Contact Information
Please provide primary contact information for your student(s).
Address
Number and Street
Your answer
City
Your answer
Province
Your answer
Postal Code
Your answer
Home Phone (Or Best Available)
XXX-XXX-XXXX
Your answer
Email Address
Your answer
Mother's Name
(If Applicable)
Your answer
Father's Name
(If Applicable)
Your answer
Additional Contact Information
Any additional contact information that we may need should be entered here:
Additional Phone Number
Please indicate number and owner
Your answer
Additional Email Address
Please indicate address and owner
Your answer
Additional Address Information
If your student lives at multiple households, please indicate any other addresses and who is the primary contact there. Postal codes are required.
Your answer
I/We are willing to assist in the following area(s):
Check all areas that apply
Other, (please describe)
Your answer
Registration Fees
Registration Fees
Please make cheques out to "Island Ukuleles A Music Society"
Required
Island Ukuleles A Music Society Membership Application
Please indicate if you wish to apply for or renew your membership to the Island Ukuleles A Music Society. Please note, a signature will be required to officially join.
I/We ______________________ wish to renew/apply for membership in the Island Ukuleles A Music Society. I acknowledge that membership requires adherence to the Society's Constitution and By-laws and a payment of an annual registration fee of $1 each.
Please enter parent name(s)
Your answer
Society Fees
**No student will be denied the opportunity to participate because of an inability to pay. Please contact Tina Horwood (Musical Director) if finances are a concern. Your confidentiality will be respected.**
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