Music Program Registration Form

Music Program Registration Form

Fill out the form carefully for registration
Student Name

First NameLast Name
Gender
Student ID
Last 4 digits
Date of birth

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDD/MM/YYYY
Parent Name

First NameLast Name
Phone Number

Area CodePhone Number
E-mail
example@example.com
Address

Block & Unit No.

Street Name

CityState / Province

Postal CodeCountry
Would like to attend:
Guitar/Keyboard/Drums
Instrument Owned:
Music Level:
Additional Remark: (If any)
Please tick before submit:

By submitting my personal information on this form, I acknowledge that Providence Care Centre (PCC) is collecting my personal data in relation to the course I am registering my child/children for. I hereby consent to the collection, usage or disclosure of my personal data for the purpose of maintaining and updating of the records. In view of this, I also consent to be contacted by telephone, SMS or email messages for any other PCC-related matters or events in future.
Please be advised that we will contact you via phone or email to inform you about the available timeslots/confirmation. Thank you.
Should be Empty: