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Student Info

First Name *
Last Name *
Gender * Male 
Female 
Grade in 2017-2018 year *
School *

Health and Medical Information

Allergies and other Medical conditions that may impact your childs participation *
Medications taken by your child *
Emergency Contact non-parent *
Emergency Phone *( ) -

Courses

Courses Middle School Band Session 1  instrument and years played 

Middle School Band Session 2  instrument and years played 


Parent / Guardian 1

First Name *
Last Name *
Email *
Phone *( ) -

Parent / Guardian 2

First Name
Last Name
Email
Phone ( ) -



* = required field

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