Miamisburg Bands Concert Band Registration 2017-2018
Student First Name
Student Last Name
Must be 6 digits. Please add a zero to the beginning if your student only has 5 digits.
Band in Which Student is Enrolled
Check All That Apply
Star City Jazz Band
Parent Email Address #1
Please list all email addresses in which you would like to receive information; if possible, please also list emails for all parents, stepparents, etc.
Email Address #2
Email Address #3
If more than three email addresses, please list all here, separated by commas
Parent Phone Number #1
Phone Number #2
Phone Number #3
Instrument Brand (Yamaha, Conn, Gemeinhardt, etc.)
Please answer this only if you play an instrument NOT owned by the Miamisburg City Schools
Instrument Serial Number
Please leave blank if you are unsure.
Insurer Providing Coverage on Instrument
Terms of Acceptance
I understand that as my student is enrolled in the Miamisburg Band Program, all performances are mandatory and we agree to follow all procedures of the program as set forth in each class's syllabus and performance calendar.
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