Grade 7 Moose Jaw Band Registration

Please complete the form below. Required fields marked with an asterisk *

Today's Date*

Answer Required

Student Information

Last Name*

Answer Required

First Name*

Answer Required

Parent/Guardian Information

Last Name*

Answer Required

First Name*

Answer Required

Email*

Answer Required

Phone Number*

Number Required

Relationship to student*

Answer Required

Mother

Father

Guardian

Other:

Instrument*

Answer Required

I allow my child’s picture to be shown on the band website.*

Answer Required

Yes

Payments

The annual fee for band is for transportation and materials, and does not provide an instrument.

How would you like to pay?*

Answer Required

Cheque - full amount $110

Credit Card - full amount $110

Cash $110

Postdated cheques - $55 September 1, $55 October 1(Make cheques payable to HTCSD)

Cheques may be mailed to: 445 13th Avenue NE Moose Jaw S6H 6B9

Grade 7 Band Fees - check this box to pay via credit card.

Price: $110.00

Please fix the highlighted areas below before submitting.