Student First Name *

Student Last Name *

Student Age 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

Student Gender Female Male

Current Grade in School * A - Kindergarten B - First C - Second D - Third E - Fourth F - Fifth G - Sixth H - Seventh I - Eighth J - Freshman K - Sophomore L - Junior M - Senior

Vocal Part, If Known

If your child has any musical experience, please share. Note: musical experience is not required for membership.

Please explain any behavioral or learning needs along with anything else that might be helpful to our directors.

Main Parent First Name

Main Parent Last Name

Main Parent Relationship to Child Mother Father Other

Main Parent Email

Main Parent Phone

Address Line 1

Address Line 2

City

State/Province Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming American Samoa Federated States of Micronesia Guam Marshall Islands Northern Mariana Islands Palau Puerto Rico U.S. Minor Outlying Islands Virgin Islands Armed Forces Americas Armed Forces Europe, the Middle East, an Armed Forces Pacific Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Territory Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory

Zip/Postal Code