2022-2023 Living Word Lutheran Junior Winds Registration

Student's Name *

First Name Last Name

School Attended: *

Grade entering Fall 2021 *

5th Grade 6th Grade 7th Grade 8th Grade

Shirt Size: *

Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult X-Large

Instrument(s) Played *

Years in Band *

Has student had private lessons before? (Y/N) *

If yes, please provide name of instructor.

Does the student have any allergies, chronic illness, or medical conditions that the instructors should be aware? If yes, please describe.

Name *

First Name Last Name

Parent/Guardian E-mail *

Phone Number *

Area Code Phone Number

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Emergency Contact's Name *

First Name Last Name

Relationship

Phone Number *

Area Code Phone Number

Junior Winds Registration: *

Junior Winds Registration Fee $ 150.00

Total $ 0.00

Informed Consent and Acknowledgement

I grant permission to participate in Living Word Lutheran Junior Winds. I understand that attendance is mandatory for all performance dates. I understand that rehearsal attendance is essential out of respect for the ensemble as a whole and to assure that my student is prepared for performances. If the need arises for my student to miss a rehearsal, I will communicate with the director prior to that rehearsal.

I hereby authorize, in the case of medical emergency, the director to act according to their best judgment. I waive and release Living Word Lutheran High, the director, and instructors from liability for any injuries incurred while at rehearsals and performances.

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

Living Word Lutheran Junior Winds

Student Information

Parent/Guardian Information

Emergency Contact Information

Registration Payment