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First and Last Name
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Birthdate
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Student Email (this is our PRIMARY form of communication. It is your responsibility to notify us if this will not work for you.)
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Student Cell
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Mailing Address
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City, State & Zip
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Home Phone
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Instrument
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Years Played
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Musical Groups Student Has Played In
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Private Music Teacher
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Teacher Phone
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School
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School Music Instructor
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Grade
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Parent/Guardian(s) Names(s)
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Mailing Address, Phone, Email IF DIFFERENT from Student
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Parent Email
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Home Phone
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Parent/Guardian(s) Cell Phone #(s)
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Health Care Provider
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Phone
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Dentist
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Phone
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Health Insurance Carrier
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Policy #
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Allergies or Other Health Concerns
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Emergency Contact & Phone IF PARENT CANNOT BE REACHED
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Auditions will be held between March 11-14, 2010 at the University of Portland. First Choice of audition time is:
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Second choice for audition time is:
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Select Shirt Size:
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Payment Method
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Check
Credit Card (Mastercard/Visa only)--3% fee applies
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Please call us with your credit card number if you prefer to pay by this method.
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