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Teupha Day Registration | March 23rd

Student Name

Student Email

School Name

Current Student Grade

Instrument

Musical Awards/Honors

Private Lesson Teacher (if applicable)

Band Director

T-Shirt Size

Have You Attended a Teupha Event Before?

Preferred Pizza Topping

Pertinent Medical Info

Parent/Guardian Name (Primary Contact)

Parent/Guardian Email (Primary Contact)

Parent/Guardian Phone Number (Primary Contact)

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Phone Number

I accept the terms & conditions of theMedia Release Consent Form

I accept the terms & conditions of the Cancelation/Refund Policy

Do you have any questions or comments?

Thanks for registering for Teupha Day. See you on March 23rd!

Sponsored By

Prof Mouthpiece

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