Parent's Name *

First Name

Last Name

Phone *

(###)

###

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Child's Name *

First Name

Last Name

On which proficiency level is your child with the trumpet? *

Beginner

Intermediate

Advanced

Do you need financial assistance? *

No

Yes

What is your child's size for a ladies' T-shirt? *

Youth Small

Youth Medium

Youth Large

Adult Small

Adult Medium

Adult Large

Other

EMERGENCY CONTACT *

First Name

Last Name

Phone *

(###)

###

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I give permission for Girls Play Trumpets Too to use images, video, audio, film, or other materials including my child for promotion of the program. I authorize Girls Play Trumpets Too to care for my child during the time they are in class or participating in an GPTT sponsored trip. I also give permission for GPTT to administer and/or obtain medical treatment for my child in the event that I cannot be reached. *

Yes (To the terms above and sign my child up for GIRLS PLAY TRUMPETS TOO: SATURDAY MUSIC PROGRAM)

You must agree to the terms below by checking each box to borrow a trumpet for Girls Play Trumpets Too.

I understand that this instrument must be returned if my child decides not to continue participating in Girls Play Trumpets Too.

Instruments may be returned to our office or your child's program site (St. Charles Ave. Baptist Church)

I understand that I am financially responsible for any damages done to the instrument while it is signed out under my child's name.

I agree to cover the cost of any damages done to the instrument.

I understand that this instrument is loaned to my child for use during the time they are enrolled in Girls Play Trumpets Too. No siblings, friends, or classmates should play this instrument. *

Yes