Rock Band Enrollment Form

Rock Band Enrollment Form
Musician Information
Musician's Name

First NameLast Name
Main Instrument
Secondary Instrument
Musician's Music Teacher
Music Teacher Phone Number
Age
Date of Birth

MonthDayYear
Date
Email
example@example.com
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School Name
Additional Info
example@example.com
Musician Photo (Optional)

Browse Files

Cancelof
Parent/Guardian Information
The parents/guardian listed below will also be the primary emergency contact person.
Name

First NameLast Name
Relation
Phone Number

Area CodePhone Number
Picture upload

Browse Files

Cancelof
Name

First NameLast Name
Relation
Phone Number

Area CodePhone Number
Picture upload

Browse Files

Cancelof
Payment Details
Method of Payment
My Products
prevnext( X )
One Week$400.00

Total $0.00
Authorization
- I, the parent/guardian of the musician, certify that I have read the Summer Camp Policies and agree to adhere and abide by all policies and procedures therein
- By signing below, I give Culture Verse Studios permission to use photographs of my child for promotional purposes via social media and cultureversestudios.com
- I release Culture Verse Studios from any responsibility in case of accident, illness, or injury during my child's enrollment.
- I confirm that all information given in this form is true, complete, and accurate.
Parent/Guardian Signature

Powered by Jotform SignClear

Payment Methods

Debit or Credit Card

Fastlane Checkout

Choose from one of the PayPal options to make your payment.

Contact Info

Payment Info

Musician Information