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Hershey Elementary Instrument Ensemble Sign-ups
This form is the official sign-up to play an instrument at Hershey Elementary School. Please only fill out this form after viewing the parent night presentation. One form per 4th or 5th grade beginner student.
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* Indicates required question
Email
*
Your email
Student First Name
*
Your answer
Student Last Name
*
Your answer
Student's Grade Level
*
4th Grade
5th Grade
Required
Homeroom
*
Dunlop - 49
Edwards - 42
Gardner - 41
Gehman - 50
Mark - 40
Katerman - 51
Prestidge - 45
Querry - 43
Siminitus - 47
Wood-48
Coleman - 61
Hicks - 55
Miller - 62
Patrick - 65
Slater - 57
Stahl - 53
Termin - 56
Umberger - 63
Westervelt - 58
Williams - 59
Student's Instrument Choice
*
Alto Saxophone
Baritone
Cello
Clarinet
Flute
French Horn
Harp
Oboe
Percussion
String Bass
Trombone
Trumpet
Tuba
Viola
Violin
Undecided
How are you obtaining an instrument?
*
renting/purchasing from Menchey's Music (band & orchestra)
Renting or purchasing from J.R. Judd Violins (orchestra)
Already own our instrument
School Provided
Other:
If you answered 'other' above, please specify where you are obtaining your instrument.
Your answer
Parent/Guardian #1 Name
*
Your answer
Parent/Guardian #1 E-mail Address
*
Your answer
Parent/Guardian #1 Phone Number
*
Your answer
Parent/Guardian #2 Name
Your answer
Parent/Guardian #2 E-mail Address
Your answer
Parent/Guardian #2 Phone Number
Your answer
Is there another adult that you would like to have added to out contact list? Please list their name, contact information, and relation to student below.
Your answer
A copy of your responses will be emailed to the address you provided.
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