Mmb/Pal Band Summer Music Camp Registration Form

MELBOURNE MUNICIPAL BAND SUMMER YOUTH BAND REGISTRATION FORM (PLEASE PRINT ALL INFORMATION) Student’s Name______Parent’s Name______Address______City______Zip______Home Tel______Cell Phone______Work Tel______Email______School Now Attending(2013-2014)______Current Grade____ School Attending in the Fall of 2014______How Did You Hear About Our Program?______Did You Participate In Our Program Before?______If Yes, When______Year(s) Instrument: (please circle one choice) FLUTE CLARINET OBOE ALTO SAXOPHONE TENOR SAXOPHONE TRUMPET FRENCH HORN BARITONE HORN TROMBONE TUBA SNARE DRUM KIT BELLS

Please check one: ____I will be learning the instrument circled above for the first time. ____I have played the instrument circled above for______(Number of years)

Please check one: ____I will be renting from: Horn Section Marion Music Brass & Reed (Please circle one) ____I own my instrument

I also play ______How many years?______(name of instrument(s) Please circle the dates you are able to attend:

Student’s Signature______

Parents Signature______Please return this form by Friday, May 30, 2014 to: Mrs. Missey Howald Executive Assistant Summer Youth Band 585 Lake Victoria Circle Melbourne, FL 32940