Domini-Band Day

Participant's Name*
First Last
Date of Birth*
Elementary School*
Grade Level*
T-Shirt Size*
Instrument*
Number of Years in Band*
Address*
Street Address Address Line 2 City State ZIP Code
Parent/Guardian Name*
First Last
Primary Phone Number*
Email*
Emergency Contact Name*
First Last
Emergency Contact Phone Number*
Relationship to Student*
Do you know any Dominican alumnae? If so, please list her name and your relationship to her.
Please list any allergies or medical conditions:
Insurance Card
Accepted file types: jpg, jpeg, pdf, Max. file size: 32 MB.
If you do not attach a photocopy of the insurance card, please mail it to: St. Mary's Dominican High School, ATTN: Brenda Castillo, 7701 Walmsley Avenue, New Orleans, LA 70125. A photocopy of insurance card is required for participation.
By checking this box, I request that Dominican allow my daughter to participate in the 2025 Domini-Band Day on Saturday, October 4, 2025. I release St. Mary's Dominican High School, the club moderators, coaches, and/or chaperones approved by the Administration from liability in any manner. In case of emergency, I give my permission for the club moderators, coaches, and/or chaperones to seek medical care as needed for my daughter if I can not be contacted. Additionally, I authorize the use of my daughter's photos for the purpose of publicity and marketing materials and on the St. Mary's Dominican High School website.*
- Parent/Guardian Signature
By checking this box, I request that Dominican allow my daughter to participate in the 2025 Domini-Band Day on Saturday, October 4, 2025. I release St. Mary's Dominican High School, the club moderators, coaches, and/or chaperones approved by the Administration from liability in any manner. In case of emergency, I give my permission for the club moderators, coaches, and/or chaperones to seek medical care as needed for my daughter if I can not be contacted. Additionally, I authorize the use of my daughter's photos for the purpose of publicity and marketing materials and on the St. Mary's Dominican High School website.
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