8th Grade Student Data Sheet 21-22

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Please fill out this form completely so that we can have accurate records for your child.

There are several items on this form that read, "Data Placeholder ( Please Do NOT type a response here)". These data placeholders need to be left blank to facilitate the band program uploading your information correctly to our mass email database.

If you have any questions, please contact Lufkin MS Band 8th Grade Band Director Tommy Smith at tsmith@lufkinisd.org or 936-633-6136

Student ID *

Student First Name *

Student Middle Name *

Student Last Name *

Grade *

8th

Birth Date Month (mm) *

Birth Date Day (dd) *

Birth Date Year (yyyy) *

Gender *

Female

Male

Data Placeholder ( Please Do NOT type a response here)

Address (Street) *

City *

State *

Zip *

Phone *

Student Cell (If none leave blank)

Student Email ( If none leave blank)

Data Placeholder ( Please Do NOT type a response here)

Adult 1 First Name *

Adult 1 Last Name *

Adult 1 Address (Street) *

Adult 1 City *

Adult 1 State *

Adult 1 Zip *

Adult 1 Work Phone

Adult 1 Home Phone

Adult 1 Cell Phone

Adult 1 Email *

Adult 1 Occupation

Data Placeholder ( Please Do NOT type a response here)

Option 1

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Adult 2 First Name *

Adult 2 Last Name *

Adult 2 Address (Street) *

Adult 2 City *

Adult 2 State *

Adult 2 Zip *

Adult 2 Work Phone

Adult 2 Home Phone

Adult 2 Cell Phone

Adult 2 Email *

Adult 2 Occupation

Submit

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