Community Music Registration – Encore Community Music Association

2017-18 COMMUNITY MUSIC REGISTRATION FORM

FALL SEMESTER BEGINS SEPTEMBER 25, 2017
West Middle School
60 Monroe Street, Westminster

Performing Ensemble (Select one)*
- Symphonic Band - 2+ yrs experience
- Chamber Orchestra - 2+ yrs experience
- Enrichment Band - 4 mos-2 yrs experience
- Enrichment Orchestra - 4 mos-2 yrs experience
Musician Name*
First Last
Instrument*
Please select from the drop down list above.
Experience on primary instrument*
Parent Name (if different than musician name)
First Last
Phone Number*
Email*
Home Address*
Street Address City State ZIP Code
I understand that by registering for this program, I irrevocably release the Encore Community Music Association, Carroll County Arts Council, Carroll County Public Schools and Carroll County Government from any and all claims or liability arising from the activity, the instructors or any other person participating in the program. I also agree that photographs taken of my child or myself while participating in this activity may be used for publicity purposes. I understand it is my responsibility that I/my child attend rehearsals and agree to make payments at the beginning of each semester. I hereby give permission for my child/myself to participate in the Encore Community Music Program.*