Music School Registration Form

Registration
Student Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birth Date*

MonthDayYear
Program choice *
Will your child attend school full-time or part-time

Full-TimePart-Time
School Hours

Regular Day 7:30am-5:30pmExtended Day 7:30am-6:15pmBefore School 6:00am-5:30pmBefore School/ Extended Day 6:00am-6:15pm
Parent Contact
Email Address:
Parent/Guardian

First NameLast Name
Relation to child
Emergency contact
List of adults 18 year old or older who can pick student up must have identification
Should be Empty: