School of Brass Registration Form

Student Name(Required)

First Name Last Name

Parent/Guardian(s)(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email (Primary)(Required)

Email (Secondary)

Phone (Primary)(Required)

Phone (Secondary)

Current Grade(Required)

Which program are you applying for?(Required)

MiniKids (K-3)

Junior Brass Band (4-7)

Youth Brass Band (8-12)

Do you have an instrument?(Required)

Yes

If yes, what instrument?

Please select one of the following(Required)

I am a Penn Hills resident

I am not a Penn Hills resident

If you are not a Penn Hills resident, would you like to apply for a scholarship?

Yes

School Name(Required)

Additional Notes