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
7