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2015 SUMMER INSTRUMENTAL MUSIC
July 6-23, 2015 (Monday – Thursday)
Mead Junior High School
1765 Biesterfield Rd.
Elk Grove Village, IL 60007
(847-357-6000)
2015 SUMMER MUSIC REGISTRATION FORM
Please complete this form accurately.
: Refunds will only be issued if the District cancels classes.
Student Name ________________________________________________________
School ‘14/’15 _____________________________________ Grade ‘14/’15: _______
Cost: $35.00
What instrument does student currently play? _________________________________
District 54 Fine Arts Dept. is pleased to offer a summer instrumental
music opportunity for band and orchestra students.
♫ INTERMEDIATE BAND
9:00 - 10:00am
Requirement for entry: Students must have completed 5th grade and had
lessons on their instrument for one school year.
Parent/Guardian Name __________________________________________________
Address _____________________________________________________________
Street Name
___________________________________________________ ________________
City
♫ ADVANCED BAND
10:15 - 11:15am
Requirement for entry: Students must have completed 6th grade and had
ZIP
Phone: _______ __________________ ; (alt. phone ) _______ _________________
e-mail: ______________________________________________________________
lessons on their instrument for two or more consecutive years.
♫ INTERMEDIATE ORCHESTRA
9:00 - 10:00am
Requirement for entry: Students must have completed 5th grade and had
lessons on their instrument for one school year.
♫ ADVANCED ORCHESTRA
10:15 - 11:15am
Requirement for entry: Students must have completed 6th grade and had
lessons on their instrument for two or more consecutive years.
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Registration is by mail only;
Must be received by Thursday, June 25, 2015.
Mail this form*, with a check made out to School District 54, to:
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Questions? Call your child’s instrumental music teacher.
(After June 12, contact Fine Arts office @ (847) 357-5138)
Transportation is not provided by District 54.
It is the parent’s responsibility to make sure your child
is picked up on time.
Please keep this side of the form for future reference;
No confirmation will be sent.
 Intermediate Band  Intermediate Orchestra
CHECK ONE:  Advanced Band
 Advanced Orchestra
PLEASE
Summer Instrumental Music
School District 54
524 E. Schaumburg Rd.
Schaumburg, IL 60194
*Please keep the left side of this sheet for reference;
No confirmation will be sent.
If you have any questions, please contact your child’s instrumental
music teacher
____________________________________________________
Parent/Guardian Signature
REV. 3/17/15