Note: This should be the student's legal name; if a student has another name they prefer to go by, please provide it in the next section.
Your answer
Student's Preferred Name
Your answer
Graduation Year *
Choose
2020 (Senior)
2021 (Junior)
2022 (Sophomore)
2023 (Freshman)
2024 (8th grade marcher)
School - Fall of 2019 *
Choose
LC
LN
BMS
FCV
Men's T-Shirt Size *
Choose
XS
S
M
L
XL
2XL
3XL
Marching Band Instrument *
Your answer
Dietary Restrictions
Mailing Address: Street *
e.g. 12345 Anywhere Street
Your answer
Mailing Address: City *
Your answer
Mailing Address: State *
Your answer
Mailing Address: Zip Code *
Your answer
Home Phone/Primary Phone Number *
Please provide us with the best phone number (with area code) to reach you, and indicate whether the number is a cell or home number. (e.g. Cell: 999-123-4567)
Your answer
Does the student have a smartphone? *
PARENT/GUARDIAN INFORMATION
Parent/Guardian #1 *
Your answer
Parent/Guardian #1 Relationship to Student *
Your answer
Parent/Guardian #1 Cell Phone or Primary Phone Number *
Please provide us with the best phone number (with area code) to reach you, and indicate whether the number is a cell or home number. (e.g. Cell: 999-123-4567)
Your answer
Parent/Guardian #1 Work Phone Number
Please include the area code and extension, if applicable.
Your answer
Parent/Guardian #1 Email Address *
Your answer
Parent/Guardian #2
Your answer
Parent/Guardian #2 Relationship to Student
Your answer
Parent/Guardian #2 Cell Phone or Primary Phone Number
Please provide us with the best phone number (with area code) to reach you, and indicate whether the number is a cell or home number. (e.g. Home: 999-123-4567)
Your answer
Parent/Guardian #2 Work Phone
Please include the area code and extension, if applicable.
Your answer
Parent/Guardian #2 Email Address
Your answer
EMERGENCY CONTACT INFORMATION
Please provide at least one individual that MPLT staff can contact in the event of an emergency. Note: This should be someone other than a parent or guardian.
Emergency Contact #1 *
Your answer
Emergency Contact #1 Phone Number(s) *
Please provide at least one phone number with area code, and indicate whether the number is work, cell, home, etc. (e.g. Cell: 999-123-4567; Home: 999-321-7654)
Your answer
Emergency Contact #1 Relationship to Student *
Your answer
Emergency Contact #2
Your answer
Emergency Contact #2 Phone Number(s)
Please provide at least one phone number with area code, and indicate whether the number is work, cell, home, etc. (e.g. Cell: 999-123-4567; Home: 999-321-7654)
Your answer
Emergency Contact #2 Relationship to Student
Your answer
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