Kids Club – 4th Grade Band – PS 321 – 180 7th Avenue, Brooklyn NY 11215

You are paying for 4th Grade Band for the 2022-2023 term.

"*" indicates required fields

Child's Name*

First Last

Child's Classroom Teacher*

Parent/Guardian Name*

First Last

Parent/Guardian Email*

Parent/Guardian Phone*

Parent/Guardian #2 Name

Please only fill out if the second parent/guardian needs to be informed about Kids Club updates

First Last

Parent/Guardian #2 Email

Parent/Guardian #2 Phone

4th Grade Beginning Band Payment*

1/2 4th Grade Band Payment ($425)

Full 4th Grade Band Payment ($850)

Donation – Type in your amount

Band requires a lot of maintenance and instrument care. If you are able to, please make an additional payment that will go directly towards accessories and band materials for the next two years. This program is very special to our school and your donation can help us get things like new instrument cases, music stands, music books, accessories for each instrument and much more.

Total

Payment Method*

Visa

Card Number Expiration Date Security Code Cardholder Name

Kids Club – 4th Grade Band

PS 321 William Penn

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