Pine Road Elementary School Band and Orchestra Enrollment 2020-2021
Please complete the following information for music lesson enrollment. You will be prompted to request your instrument of choice on the following pages. An electronic copy of this form will be sent to you upon completion. You can make updates or changes to this form. Please email Mr. DeGeorge at gdegeorge@lmtsd.org with any questions.

**SPECIAL NOTE AS OF 8/27/20**: At this time percussion and alto saxophone classes are full. You are welcome to indicate those selections as a first choice, but please indicate a second option on your enrollment form. We will reach out to you individually for confirmation of instrument placement.
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Email *
Parent/Guardian First Name *
Parent/Guardian Last Name *
Phone Number
This number will be used in our Remind App for text message reminders. You can enroll an additional parent or guardian (e.g., spouse, grandparent, etc.) on the final page of enrollment.
Student First Name *
Student Last Name *
Grade Level for 2020-2021 *
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