Student Interest/Information Form


Confidential
Member Status
New Member:     Returning Member:    
 


Student Contact Information
Student Name:
Address:
Address:
City: Zip:    
Home Phone: --
Cell Phone: --
Student Email:

Parent Contact Information
Parent(s) Name(s):
Please provide address & phone if different than student
Address:
Address:
City:      Zip:    
Home Phone: --
Cell Phone: --
Cell Phone: --
Parent's Email:
Receive e-mail news at above address:    Yes:     No:
Parent's Email:
Receive e-mail news at above address:    Yes:     No:

Additional Information
Instrument(s):
Graduation Year:
Current Grade:
8th Grade Students Only:    Allen:     Lemoyne:     NC:
Interests:
Marching Band:
Concert Band:
Wind Ensemble*:
*Subject to approval from director
Jazz Band:
Indoor Guard:
Percussion Ensemble:

Notes