AMP Summer Series Application

Student First Name (required)

Student Last Name (required)

Address (required)

City (required)

State (required)

Zip Code (required)

Name of Parent(s)/Legal guardian(s) (required)

Parent Email (required)

Parent Home Phone (required)

Parent Cell Phone

Emergency Contact Name (required)

Emergency Contact Number (required)

Emergency Contact Email (required)

Student Birthday (mm/dd/yy) (required)

Age of Student on June 4, 2018 (required)

Grade Level in August 2018 (required)

School Student is Attending for 2018-2019 (required)

Does child qualify for free/reduced priced meals at school? (required)
 Yes No

Food Allergies (required)

Medical Conditions

Instrument student will play at 2018 AMP Summer Series

How many years have you played this instrument?

Name of school music teacher (if any)

School Music Teacher Email

School Music Teacher Phone

Name of private music teacher (if any)

Private Music Teacher Email

Private Music Teacher Phone

Do you own your own instrument?
 Yes No

Will you need to borrow an instrument from AMP?
 Yes No

How many years of choir experience do you have (if any)?

How many years of band experience do you have (if any)?

How many years of orchestra experience do you have (if any)?

Please select student's t-shirt size (adult sizes listed):

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