Dublin Youth Brass Band Workshop 2022

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First Name

Last Name

Grade level

6th grade

7th grade

8th grade

9th grade

10th grade

11th grade

12th grade

college volunteer

Clear selection

School

First choice brass band instrument

soprano cornet

cornet

flugalhorn

tenor horn

baritone

tenor trombone

bass trombone

euphonium

tuba (bass)

percussion

Clear selection

Instruments I'm willing to play

soprano cornet

cornet

flugelhorn

tenor horn

baritone

tenor trombone

bass trombone

euphonium

tuba (bass)

percussion

Clear selection

If you play a bass clef instrument, will you need bass clef music?

yes

Clear selection

Name of private instructor (if you have one)

How many years have you been playing your instrument?

Consent statement:

I consent to have my child's photo and video shared online and/or in print (no names will be used without first contacting parent/guardian for permission)

I consent to only to a full group photo and video being shared with my child in it. I do not consent to any individual photos of my child being shared online and/or in print. (no names will be used without first contacting parent/guardian for permission

I would like to opt my child out of all media both print and online.

Parent/Guardian name

Parent/Guardian email

Parent/Guardian phone number

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