Moose Jaw Holy Trinity Bands 2017-2018 Registration Form PLEASE SUBMIT BY FRIDAY, SEPTEMBER 8, 2017

--Please print clearly with pen.

Date of Application___________________________________

Student’s Name_____________________________________

Student’s Birthdate___________________________________

Parent/Guardian Name(s)______________________________________________________

Address_____________________________________________________________________

Postal Code_______________ Phone (H) ______________ (W) __________________

Parent/Guardian e-mails (for newsletter) ____________________________________

______________________________________________________________________

School __________________________________

Instrument__________________________________________________

Circle one: I allow / do not allow my child’s picture to be shown on the band website.

Signature of Parent/Guardian: __________________________________________

__________________________________________________________________________________

A total of $120 ($20 for materials plus $100 participation fee) must be included with this registration form.

Please select payment option: ***Make cheques payable to: “Holy Trinity Div22 – Band”

A. 1 Payment (cash and cheque) of $120

Cheque must be post-dated Sep 1st , 2017 Cheque # _________

B. 4 Payments (cheques only)

Initial $45 post-dated Sep 1st and three $25 post-dated Oct 1st, Nov 1st and Dec 1st

Cheque #’s __________ __________ __________ ____________

$45 - Sep 1st $25 - Oct 1st $25 - Nov 1st $25 - Dec 1st

C. 4 Payments – Payroll Deduction for HTCSD Employee

Initial $45 deducted in Sep, and $25 deducted in Oct, Nov and Dec.

_____________________________________________________________________ OFFICE USE ONLY

____________AMOUNT RECEIVED DATE: ______________________________

____________AMOUNT OWING INITIAL:______________________________

GRADE

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