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Clio Beginning Band Registration 2021-22
Please fill out this form by Wednesday, June 2nd, 2021
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Email
*
Your email
I understand that this form is being filled out by a parent or guardian 18 years of age or older, and that this electronic document can be used for official school data collection purposes.
*
I acknowledge this.
Required
Parent/Guardian First Name
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Your answer
Parent/Guardian Last Name
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Your answer
Best Parent Phone Number (000-000-0000)
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Your answer
Best Alternative Parent Phone Number (000-000-0000)
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Your answer
Alternative Email Address (other than what was filled out at the top of the form)
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Your answer
Student Grade (For next year)
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5th Grade
6th Grade
Required
Student First Name
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Your answer
Student Last Name
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Your answer
Student ID Number (ex. 001234)
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Your answer
What Elementary School does your student attend?
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Lacure
Garner
Edgerton
Required
Mailing Address
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Your answer
City
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Your answer
Zip Code
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Your answer
Instrument Preference
Please know that there may be a chance your student does NOT get placed on their top instrument preference. This is purely to give us an idea of how many students are interested in each instrument.
Instrument selection will be finalized when students are fitted for instruments by Port Huron Music and the directors come August.
Student 1st Instrument Choice
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Choose
Flute
Clarinet
Trumpet
Trombone
Baritone
Percussion
Student 2nd Instrument Choice
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Choose
Flute
Clarinet
Saxophone (only for rising 6th grader/current 5th graders)
Trumpet
Trombone
Baritone
Percussion
Would you like to be considered for a switch to Saxophone in 6th Grade? (Must play clarinet in 5th Grade)
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Yes
No
Not Applicable (picking a different instrument)
Has your student taken music lessons of any kind?
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Yes
No
If you answer yes to the question above, please specify the type of lessons, frequency, and for how long the student has been enrolled in lessons.
Your answer
A copy of your responses will be emailed to the address you provided.
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