2019 Instrument Sign-up Form
Upper Perkiomen School District
Elementary Band & Orchestra Student Information
Email address *
Student's First Name *
Your answer
Student's Last Name *
Your answer
School *
Classroom Teacher
Your answer
Parent or Guardian Name(s)
Your answer
Telephone Number (xxx)xxx-xxxx
Your answer
Email address for important updates
Your answer
Instrument Choice - choose 1. (Beginners, choose the instrument that you're thinking about.) *
Your answer
Participation and Photo/Video Release: I understand that participation in a performance group (this includes band and orchestra) requires regular attendance and may include photographic opportunities. As these groups are often photographed and video recorded, both with and without school district consent, I acknowledge that my child's video image may appear in a variety of public media including print and internet. Furthermore, I consent and grant the right or the Upper Perkiomen School District to make and use both photographs and video recordings of my child, without my review or compensation, for educational and promotional purposes. I release and hold harmless the Upper Perkiomen School District of any action or claim that may occur in the use of all video recordings and photographs. *
A copy of your responses will be emailed to the address you provided.
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