Grade 6 Moose Jaw Band Registration

Please complete the form below. Required fields marked with an asterisk *

Today's Date*

Answer required for "Today's Date"

Student Information

Last Name*

Answer required for "Last Name"

First Name*

Answer required for "First Name"

Parent Information

Last Name*

Answer required for "Last Name"

First Name*

Answer required for "First Name"

Parent/Guardian e-mail*

Answer required for "Parent/Guardian e-mail"

Parent/Guardian Phone Number*

Number Required

Relationship to student*

Answer required for "Relationship to student"

Mother

Father

Guardian

Other:

I allow my child’s picture to be shown on the band website.*

Answer required for "I allow my child’s picture to be shown on the band website."

Yes

Payments

How would you like to pay?*

Answer required for "How would you like to pay?"

Cheque - full amount $110

Credit Card - full amount $110

Cash $110

Postdated cheques - $55 September 1, $55 October 1(Make cheques payable to HTCSD)

Cheques may be mailed to: 445 13th Avenue NE, Moose Jaw, S6H 6B9

Grade 6 Band Fees - check this box to pay via credit card.

Price: $110.00

Please fix the highlighted areas below before submitting.