The Awesome Cooper Band website

The Awesome Cooper Band
Booster Membership Registration Form

Please Print:

Parent's/Guardian's Name: ________________________________

Student's Name: ________________________________________

Student's Classification: 9th 10th 11th 12th

Address: ______________________________________________

Zip: ____________

Home Phone: __________________________________________

Student's e-mail address: ________________________________________

Student's Cell Phone:____________________________________________

Mom's Place of Employment: ____________________________

Mom's Work Phone: ____________________________________

Mom's Cell Phone:_______________________________________

Do you text? ________

Mom's Email:__________________________________________

Dad's Place of Employment: _____________________________

Dad's Work Phone: ____________________________________

Dad's Cell Phone:______________________________________

Do you Text? _________

Dad's Email:_________________________________________

I am willing to help with Cooper Band Activites by: (circle all that apply)