GRADE 4-7 MUSIC PROGRAM ORDER FORM

This order form will allow you to purchase a pair drumsticks, a tuner (Fleetwood Campus only), and a ukulele for up to two children in a family. If you require more than two sets of instruments please complete an additional order form.

Please pay online via PayPal or input your credit card information.

Parent full name *

First name of student 1 *

Last name of student 1 *

Grade level of student 1 *

4

5

6

7

Campus *

Fleetwood

Cloverdale

First name of student 2

Last name of student 2

Grade level of student 2

4

5

6

7

Campus

Fleetwood

Cloverdale

Contact Carolyn Gerber at cgerber@surreychristian.com or 604-498-3233 if you are having trouble completing the order.

How many?

	Pair of drumsticks (two drumsticks) $4.25
	Ukulele - Fleetwood Campus $56.00
	Ukulele - Cloverdale Campus $54.00
	Tuner (required at Fleetwood Campus only) $12.00

Current Total:

C$0.00