Music Class Interest Form
Fill out the form carefully for registration
Student Name
*
First Name
Last Name
Student Age
*
Please Select
2
3
4
5
6
7
Class Selection
*
Please Select
Tuesday 11am (ages 2-4)
Tuesday 12pm (ages 4-6)
Thursday 11am (ages 4-6)
Songwriter Workshop Spring 2025
Gender
Please Select
Male
Female
N/A
Primary Parent(s) Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Parent Name
*
First Name
Last Name
Primary Email
*
example@example.com
Parent Mobile Number
*
Phone Number 2
Additional Comments (please include preferred instrument if any)
Submit
Should be Empty: