New Student Registration Form

New Student Registration Form
Parent Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *
E-mail *
example@example.com
Student Name *

First Name Last Name
Student Birth Date *

Month Day Year
Does your child have experience playing drums? *

Yes No
Which services are you interested in? (Check all that apply). *

Private Lessons Small Group Drumline
Any other information you would like for us to know?
Should be Empty: