2019 Instrument Sign-up Form
Upper Perkiomen School District
Elementary Band & Orchestra Student Information
Student's First Name
Student's Last Name
4th-5th Grade Center
Parent or Guardian Name(s)
Telephone Number (xxx)xxx-xxxx
Email address for important updates
Instrument Choice - choose 1. (Beginners, choose the instrument that you're thinking about.)
Flute (4th & 5th grade only)
Clarinet (4th & 5th grade only)
Alto Saxophone (4th & 5th grade only)
Trumpet (4th & 5th grade only)
French Horn (4th & 5th grade only)
Trombone (4th & 5th grade only)
Baritone (4th & 5th grade only)
Snare Drum (4th & 5th grade only) - director permission only; rhythm audition required for participation
Bells (percussion) (4th & 5th grade only)
2nd year student
3rd year student
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.
Yes, I agree.
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This form was created inside of Upper Perkiomen School District.