Band for a Day March 6, 2021

Sat. March 6, 2021 9:00-1:30 Ages 6-16

Registration must be completed online by hitting the "Submit" button at the end of the form. A receipt will be sent automatically to your email once payment is rendered. If you do not wish to pay online, you must come into the YMV office on Tuesdays or Friday from 9am-4pm to finalize your registration with payment. No seats will be held until payment is rendered. Please call the YMV office at (757)420-1961 with any questions.

Registration deadline: Feb. 24, 2021

Student's Name Student's Name * First Last
Student's Date of Birth Student's Date of Birth * / MM / DD YYYY
Current Grade *
Gender *

Please answer according to student's biological sex
Is there a particular instrument that you are interested in?
Address Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Home Phone - If none, write "none." *
Parent Email Address (for communication) *
Special Medical Information/Allergies/Learning Disabilities
Father's Name Father's Name * First Last
Mother's Name Mother's Name * First Last
Work Phone *
Cell Phone *
Emergency Contact: Name (not mom or dad) Emergency Contact: Name (not mom or dad) * First Last
Emergency Contact: Relationship *
Emergency Contact: Phone Emergency Contact: Phone * - ### - ### ####
If not homeschooled, what school are you attending?

Minimum of 1 year is required
Payment: *

Payment: $20.00
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Total

Band for a Day March 6, 2021

Band for a Day March 6, 2021

$0

Total

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