AMLA Latin Music Club Registration

AMLA Latin Music Club Registration

Complete the bilingual registration details for your student and review the required agreements before submitting.
Student Information
Student Full Name / Nombre completo del estudiante

First NameMiddle NameLast Name
Date of Birth / Fecha de nacimiento

MonthDayYear
Date
Age / Edad
Primary Language of Student | Idioma Principal del estudiante
School Name/Escuela
Choose Your Club
Years of Musical Experience
Instrument(s) Currently Played
No previous musical experience
Does the student currently own an instrument?
Does the student have any allergies? / ¿El estudiante tiene alergias?
Please list allergies and reactions / Indique las alergias y reacciones
Parent or Guardian Information
Parent/Guardian Full Name / Nombre completo del padre, madre o tutor

First NameMiddle NameLast Name
Home Address / Dirección de domicilio

Street Address/Dirección de domicilio

Street Address Line 2
City/CuidadState / Province/EstadoPostal / Zip Code/Codigo de ZIP
Phone Number / Número de teléfono
Please enter a valid phone number.Format: (000) 000-0000.
Secondary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address / Correo electrónico
example@example.com
Preferred Method of Communication | Método de comunicación preferido
Preferred Language | Idioma preferida
Photo and Media Release
Do you give AMLA permission to use your child’s photos, video, or audio recordings for program publicity, social media, website, or other promotional materials? / ¿Autoriza a AMLA a usar fotos, video o grabaciones de audio de su hijo(a) para publicidad del programa, redes sociales, sitio web u otros materiales promocionales?
Agreements and Signature
I understand the AMLA Latin Music Club meets every Wednesday from 4:00 PM to 6:00 PM
I understand tuition is $100 per month
I understand registration is not complete until payment has been received
I understand monthly automatic payments are available
Photo and Media Release
Parent or Guardian Signature
Review and Submit
Confirmation
Date

MonthDayYear
Date
Should be Empty:

AMLA Latin Music Club Registration

Student Information

Parent or Guardian Information

Photo and Media Release

Agreements and Signature

Review and Submit