St. Leo Beginning Band 4-8

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Class
Student*
First Name Last Name
Student Birthdate*
MM slash DD slash YYYY
Instrument Information*
Years Played*
Parent(s)/Guardian*
First Name Last Name
Address*
Street Address Address Line 2 City State ZIP Code
Phone #1*
Phone #2*
Note to Parents: If you are a 2 household family, we need the email address of the other parent/guardian so we can include them in our communication about class info from teachers, MUSE special events, workshops, etc. We strive to make sure all parents are informed but we need your help.
Email address #1*
Email address #2*
Email address #3
Emergency Contact Name*
Emergency Contact Phone*
People authorized to pick up your student (one name per line)*
Are there any behaviors or limitations that might affect your child’s participation in a group setting involving loud sounds and lots of stimulation?*
Consent*
By checking this box, I agree to the MUSE classroom protocol, I release liability, and I agree to the set billing & drop policy for my student to participate in the MUSE Instrumental Program.*

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