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Belleville West Marching Maroons Information
2022-2023 School Year
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Notice: This form must be filled out by a legal guardian of the student, and the signature at the end of the form denotes who is legally responsible for the information obtained.
Thank you for taking the time to complete this form. Your time now will help us immensely in serving your child in band.
GENERAL INFORMATION
Student Name
*
Your answer
Student Birth Date
*
MM
/
DD
/
YYYY
Student Cell Phone Number
*
Your answer
Grade in School Next Year
*
Choose
Freshman
Sophomore
Junior
Senior
Middle School/Junior High Attended
*
Choose
Central Jr High
Emge
High Mount School
Millstadt
Signal Hill
West Jr High
Queen of Peace
Cathedral
Blessed Sacrament
Zion Lutheran
St. James
Other
Primary Instrument Played
*
Choose
Flute
Clarinet
Saxophone
Horn
Trumpet
Trombone
Euphonium
Tuba
Percussion
Color Guard
Does student have Jazz Experience
*
Yes
No
Does Student Require a School Instrument
*
Yes
No
Home Address
*
Your answer
Home Phone Number
*
Your answer
Legal Guardian #1's Name
*
Your answer
Legal Guardian #1's Cell Phone Number
*
Your answer
Legal Guardian #1's Email Address
*
Your answer
Legal Guardian #1's Employer
*
Your answer
Legal Guardian #1's Work Phone Number
*
Your answer
Legal Guardian #2's Name
Your answer
Legal Guardian #2's Cell Phone Number
Your answer
Legal Guardian #2's Email Address
Your answer
Legal Guardian #2's Employer
Your answer
Legal Guardian #2's Work Phone Number
Your answer
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