Student First Name:

Student Last Name:

Date Of Birth:

Current Grade (2018-2019):

Grade (2019-2020):

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:

Parents Email (1):

Parents Email (2):

Mailing Address:

Street:

City:

State:

Zip Code:

 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:

Harlem School of the Arts and Jazz at Lincoln Center’s Beginning Band Program

Supported by The Herb Alpert Foundation, the HSJA Beginning Band is a tuition-free class consisting of 20 to 30 middle school students learning traditional woodwind and brass instruments. Students learn to play the fundamentals of their instruments and standard jazz compositions. Students will receive an instrument for the school year as part of the program. The class meets every Tuesday & Thursday from 4:30 to 6:30pm at the Harlem School of the Arts, October 2nd through June 6th with a final performance at HSA in June.

Student First Name:

Student Last Name:

Date Of Birth:

Current Grade (2018-2019):

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:

Parents Email (1):

Parents Email (2):

Home Mailing Address:

Name of middle school

 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: