Please list all your child(ren) participating in Orchestra or Band and check the corresponding box:
Student(s) _______________________________________ Gr. ___ Orchestra Concert Symphonic Marching
Band Band Band
_______________________________________ Gr. ___ Orchestra Concert Symphonic Marching
Band Band Band
_______________________________________ Gr. ___ Orchestra Concert Symphonic Marching
Band Band Band
Parent/Guardian Name: ___________________________________________________________________________________
Address*:_______________________________________________________ City___________________ Zip_____________
Phone*: ____________________________ Email*: ____________________________________________________________
*All contact information is confidential and will be used only for the purposes of this form.
Parent/Guardian Signature: ______________________________________________________ Date: ___________________
Please complete this form and return by: Monday, August 31
st
.
Roosevelt High School Music Department
1120 Nehoa Street, Honolulu, HI 96822-2566
ATTN: Mr. Gregg Abe, Music Director
Support the
Roosevelt High School Music Department
Become a Music Booster!
Suggested Membership per family $25.00 $ 25.00
Additional Donation (optional) $____________
TOTAL $____________
Check box if a confirmation letter for tax purposes is requested.
Please make your check payable to: Roosevelt Music Boosters
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