2021 – 2022 New Boston Central School Music

Instrumental Sign-up Form

Student Name: ___________________________________________________________

T-Shirt Size: { }Have Previous Year’s [ ]Y-S { }Y-M [ ]Y-L { }A-S [ ]A-M { }A-L [ ]A-XL { }A-XXL

Grade: _______ Teacher’s Name: _____________________________________________

Home Phone Number: ______________________________________________________

Parents’ Names: ____________________________________________________________

Parents’ Cell: _____________________________________________________________

Parent’s Email: ____________________________________________________________

PAYMENT OPTION for Fall Semester: (Choose one or contact Ms. Kjellander about financial assistance)
[ ] FULL PAYMENT (Band $120) [ ] PAYMENT PLAN (Band $30)

BAND LESSON PAYMENT

 The Band Fall Semester is scheduled for 12 lessons: Oct. 20–Jan.19 ($10x12 lessons)=$120
 You may either pay the balance up front or pay $30.00 due with this form and then pay
$30.00 on November 10th, $30.00 on December 8th, and $30.00 on January 5th.

***Checks should be made out to NBCS BAND with Lessons and your musician’s name in the
Memo. If you are in need of financial assistance or a special payment plan please feel free to contact
Ms. Kjellander. If a student misses a lesson you may attempt to reschedule a make-up through Ms.
Kjellander based on availability. If school is canceled, lessons are canceled. Any lessons cancelled
by Ms. Kjellander that are unable to be rescheduled will result in a $10 credit added to your account
balance and any remaining balance will be returned to you at the end of the semester if your musician
does not continue taking lessons in the spring.

Preferred Band Instrument(s): (Please circle two instruments of interest and clearly mark a 1st and 2nd
Choice). It is my intention to provide every student with their first choice instrument, but please keep in mind
that balanced sound is important in a beginner band which is why a back-up choice is helpful.

Flute Clarinet Alto Saxophone

Trumpet Trombone Percussion (Snare & Bells)

[ ]New Member/Beginner [ ] New Member with Prior Experience

*If your musician has prior experience, please elaborate here: