Student Name *

First Name

Last Name

Student Date of Birth

MM

DD

YYYY

Student Phone

This is optional if Student is under the age of 18. This is REQUIRED if Student is 18 years of age or older.

(###)

###

####

Parent Name

Required if Student is under the age of 18

First Name

Last Name

Parent Phone

Required if Student is under the age of 18

(###)

###

####

Major Track Option 1 *

Brass

Dance

Drama

Guitar

Piano

Timbrels

Major Track Option 2 *

Brass

Dance

Drama

Guitar

Piano

Timbrels