West Band & Orchestra Sign Up Form

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Student's Name *

Student's Grade *

4th Grade

5th Grade

Parent's/Guardian's Name *

Parent's/Guardian's Email address *

Parent's/Guardian's address *

Phone Number *

Who is the student's homeroom teacher? *

Mrs. Beaudreau

Mrs. Elliot

Mrs. Taylor

Would your child like to be in band or in orchestra? Band is Flute, Clarinet, Saxophone, Trumpet, Trombone, Baritone (very limited) or Percussion (Percussion is only for 2nd year students.) Orchestra is Violin, Viola, Cello or Bass

Band

Orchestra

Not sure yet

What instrument is your child's first and second choice? Please choose one in each row. (Note: there is a slider to see all of the instruments.) *

Flute

Clarinet

Saxophone

Trumpet

Trombone

Baritone

Percussion (2nd year only)

Violin

Viola

Cello

Bass

1st Choice

2nd Choice

Will you be providing the instrument? This could by owning one already or renting one from the music store.

I already have an instrument.

I want to rent one from the music store

Other:

Clear selection

I will need to use a D-11 owned school instrument. I understand that there is another form and a fee for this. I agree to pay the fee in the office. I agree to fill out the proper form. (The teacher will tell you how to access the form.) I also understand that this is based on availability. *

Yes

Maybe

Did the student play a band or orchestra instrument last year? If yes, which instrument? Do they want to continue on the same instrument?

Student Signature- I understand that by signing electronically below, I accept the responsibilities and requirements of being in the elementary instrumental music program as explained by the teacher. Note: This class lasts all year and will have public performances. The student is required to practice regularly and be prepared for classes and performances. *

Parent/Guardian Signature- I understand that by signing electronically below, I accept the responsibilities and requirements of having my student in the elementary instrumental music program. Note: This class lasts all year and will have public performances. The student is required to practice regularly and be prepared for classes and performances. I understand that this is an actual class that my student will be getting a grade for. I will support my child's decision to learn an instrument and become a musician. *

Thank you! I look forward to teaching your child! Please email me at Katherine.Kennedy@d11.org for questions.

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