Jaguar Beat Permission Form
NEW: Jaguar Beat: 4th and 5th Grade Percussion Ensemble

Who: 4th and 5th grade students interested in learning group music performance pieces through drums, xylophones, movement, and other percussion instruments.

When: After school on Mondays from 3:35 - 4:35

Where: Ms. Heilbronner's music room (352, building 2)

In addition to providing the form, students will need a black binder. If you are unable to bring a binder, see Ms. Heilbronner and one will be provided for you. You must have a completed form (either paper or digital) in order to attend the first rehearsal.

Contact Ms. Heilbronner with any questions at hheilbronner@nyos.org
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Email *
Child's Name (First and Last) *
Child's Grade *
Child's Teacher *
Parent/Guardian #1 Name *
Parent/Guardian #1 Phone Number *
Parent/Guardian #1 Email *
Parent/Guardian #2 Name
Parent/Guardian #2 Phone Number
Parent/Guardian #2 Email
My Child's Dismissal Plan: (Rehearsal ends at 4:35) *
If you chose "Caretaker" or "Other" for the question above please provide details and contact information below: *
My child has medication or allergy needs that are on file with Nurse Lucie *
Joining a music ensemble is like a team - when members are absent, the whole group product is affected. By selecting "I Agree", I agree to arrange timely pick up for my child and make my best effort to have them attend every rehearsal and performance, with the exception of instances of unavoidable schedule conflict. *
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