Grade 7 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/Guardian Information

Last Name*

Answer required for "Last Name"

First Name*

Answer required for "First Name"

Email*

Answer required for "Email"

Phone Number*

Number Required

Relationship to student*

Answer required for "Relationship to student"

Mother

Father

Guardian

Other:

Instrument*

Answer required for "Instrument"

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

The annual fee for band is for transportation and materials, and does not provide an instrument.

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

Price: $110.00

Please fix the highlighted areas below before submitting.