Register for a Class « Colorado Honor Band Association

Student Information

Name*

FirstLast

Birthday*

MM

DD

YYYY

Gender*

Male
Female

Student Ethnicity

Optional- We use the ethnicity information strictly for grant application purposes.

Ethnicity of Student

Band Instrument You Play (or will play, for beginners)*

Years' Experience*

No Prior Experience is Required to join CHBA.

Student's Shirt Size (for uniform shirt)*

Address*

Street AddressAddress Line 2CityStateZip Code

Family Information

Parent or Guardian who will be the Main Contact person*

FirstLast

Relationship to Student*

Best Phone Number in case of Emergeny or Class Cancellation*

Cell
Work
Home

Contact Phone Number*

Format: (123) 456-7890

Additional Phone Number *

Cell
Work
Home

Additional Contact Phone Number*

Format: (123) 456-7890

Occupation*

Place of Employment*

Special skills or hobbies?

Second Parent or Guardian

FirstLast

Relationship to Student*

Best Phone Number to Contact

Cell
Work
Home

Contact Phone Number

Format: (123) 456-7890

Occupation

Place of Employment

Special skills or hobbies?

Membership

Which season are you registering for?*

Which band are you interested in? *

Which band are you interested in joining?*

Class Location (Beginning Band, Fall)*

Class Locations (Beginning Band, Spring)*

Class location (Intermediate Band, Fall)*

Class Location (Intermediate Band, Spring)*

Class location (Summer Intermediates)*

Class location (Advanced Band, Fall)*

Class Location (Advanced Band, Spring)*

Class Location (Symphonic Band, Fall)*

Class Location (Symphonic Band, Spring)*

Class Location (Symphony Winds, Fall)*

Class Location (Symphony Winds, Spring)

Class Location (Summer Winds)*

Class Location (Pop-Rock Ensemble)*

School*

Current Grade*

Participation in School Band*

Yes
No

Private Lessons*

Yes
No

Private Teacher*

Prior Piano Experience*

Yes
No

Siblings currently in CHBA?

FirstLast

Email and Billing Information

Family Email*

We send the majority of our communications out via email, so please give us an address that you check regularly! We will not share this information in any way.

Please add to CHBA mailing list

Student Email (optional)

Please add to CHBA mailing list

Other Applicable Email

Please add to CHBA mailing list

Person Responsible for Billing*

FirstLast

We typically send billing statements via email, but we will send them by mail upon request. Please indicate your preference: *

Email
Snail Mail

Billing Email (if different from above)

Billing Address (If different from above)

Street AddressAddress Line 2CityStateZip Code

Emergency Contact Information

In the event that the primary or secondary guardian cannot be reached, please provide emergency contact information. If this is no different from the parents given above, please leave blank.

First Emergency Contact

FirstLast

Relationship to Student

Phone is:

Cell
Home
Work

Phone

Second Emergency Contact

FirstLast

Relationship to Student

Phone is:

Cell
Home
Work

Phone

Does student have food allergies or other chronic problems that we should know about?*

Promotional Release

This form specifies whether a student's guardians do or do not release CHBA to to use photos, videos, etc. of their student in our promotional materials.

I give consent

I, the aforementioned Legal Guardian of the named Student, give my consent to authorize Colorado Honor Band Association the use and reproduction of any and all photographs, video, or electronic recordings taken of the named Student above during involvement in Colorado Honor Band Association's educational and musical programs. I authorize the use, reproduction, and electronic posting of any recording referred to above for any reasonable purpose including press releases, marketing materials, presentations, and website photographs and testimonials without acknowledgment and without being entitled to remuneration or compensation. I acknowledge and agree that the ownership of such recordings will be retained by Colorado Honor Band Association. The undersigned, on behalf of the above named individual, does hereby release Colorado Honor Band Association, its officers, directors and assigns from any and all liability, costs, or damages resulting from the use of the images described above.

I do not give consent

Date*

Primary Legal Guardian Typed Signature*

FirstLast

Miscellaneous

How did you hear about CHBA?

Questions or comments?