Staples Polka Band and Club Admission Form

School email address *

First and last name *

Do you have an interest in Alpine/polka music? *

Yes

No

Do you play an instrument or sing? *

Yes

No

If so, what instrument(s) do you play? (check all that apply)

Accordion

Acoustic guitar

Bass guitar

Standing bass

Trombone

Vocals (singing)

Tuba/sousaphone

Other:

How often will you be able to attend our meetings? (On Monday and Wednesday) *

Very often

Often

Somewhat often

Not that often

Rarely