Worthington Middle School Summer Band 2007

Registration Form

Registration form is due to Mr. Andersen at the Middle School or Mrs. Jensen at Prairie Elementary Friday, June 1. Place registration form and check made out to “WMS Summer Band” in a sealed envelope with students name on it.

Please fill out completely. Thank you!

Student Name___________________________________________________________

Parent’s Names__________________________________________________________

Address of parent student lives with__________________________________________

_________________________________________

Phone number (day)____________________ (evening)________________________

Student’s grade next fall________________

Student’s band instrument_______________

VALLEYFAIR TRIP

Can you (band student) go on the Valleyfair trip? Yes or No (circle one)

Could a parent chaperone the Valleyfair trip? Yes or No (circle one)

Parent name__________________________ Phone__________

*Mr. Andersen will contact you to confirm if you are needed to chaperone.

Polo Shirts

Please mark your Polo shirt size. (Adult sizes)

S M L XL XXL Already have polo shirt (Jazz One shirts are ok)

If you would like to pay for your polo shirt now, please write a separate check to:

“WMS Band Activity Account” for $10.00.