Part 1
To be completed by the parent

student first name

student last name

date of birth

current grade (2019-20)

grade (2020-21)

instrument

parent(s) or guardian(s) first name(s)

parent(s) or guardian(s) last name(s)

home phone number

Work phone number

parent cell (1)

parent cell (2)

parent email (1)

parent email (2)

mailing address:

street

city

zip code

name of school

name of music program (if applicable)

music teacher, band director, or guidance counselor's name

music teacher, band director, or guidance counselor's email

Part 2
I, the parent or guardian, certify to the best of my ability that the information in this application is correct, and electronically sign my name below:

I verify that I am 13 years of age or older