Freestyle Student Registration

Program Selection

Student Information

Student's Name

First NameLast Name

Student Nickname

Student Birth Date

MonthDayYear

Student Grade

Student School

Student Gender

Race

Student Shirt Size

Student Pant Size

Student Phone Number

If student doesn't have a phone, enter parent's number.Format: (000) 000-0000.

Student Email

If student doesn't have an email, enter parent's email.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Interest (check all that apply)

Parent/Guardian Information

Parent Name

First NameLast Name

Home Number

Format: (000) 000-0000.

Parent Cell Number

Format: (000) 000-0000.

Parent E-mail

example@example.com

Household Income

Emergency Information

Emergency Contact's Name

First NameLast Name

Emergency Relationship

Emergency Phone Number

Format: (000) 000-0000.

Alt. Phone Number

Format: (000) 000-0000.

Are you willing to participate in fundraising?

Do you give permission for photographs of your child to be used or publications, websites, or other music related items used for communication and/or publicity purposes of The Freestyle Percussion Foundation?

Confirmation: BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Signature

Student Registration Form