COMMUNITY UNIT SCHOOL DISTRICT 95
Participation Fee Form for
Elementary Band/Orchestra/Chorus
Student Name: _______________________________________________ Grade:__________
Address _____________________________________________________________________
Phone Numbers: (h)____________________ (c)________________ (w) __________________
School ____________________________Classroom Teacher___________________________
I, _______________________________________ (parent/guardian), grant permission for my
child ,__________________________________ (student name) to participate in (circle the appropriate
ensembles):
ORCHESTRA
CHORUS (4th & 5th Grade)
BAND (5th grade only)
I understand that I must make arrangements for before school transportation as required by the
specific activity.
Parent/Guardian Signature__________________________________________ Date____________
A $25.00 fee is required of all elementary and middle school students who participate in music
ensembles. If your child registers for more than one ensemble, one $25.00 fee is required for each
ensemble.
Checks should be made payable to CUSD 95. The Form and Payment are due by __________________.
Please return this signed form (one form per student) and the $25.00 fee to your school office.
Office Use only:
Payment Date: _________________
Check #/Cash:__________________