FREDERICKSBURG Registration

REGISTRATION PAGE - ONE PER STUDENT PLEASE

* Indicates required field

Student Name *

First

Last

Select Your Instrument *

School *

Grade for school year starting in August *

Age *

Parent/ Legal Guardian Name *

First

Last

Parent Email *

Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Emergency Contact Name *

First

Last

Relation to Student *

Emergency Contact Phone Number *

Must be completed by a parent or legal guardian *

My child has permission to have photographs and audio/visual taping done for all manner of media publication associated with HCYO. My child has permission for medical care in an emergency.

Special Medical Information *

Submit

Fredericksburg Registration

REGISTRATION PAGE - ONE PER STUDENT PLEASE

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