After School Registration Form - Music Teachers Collaborative

Parent Information
Parent Name*
First Last
Email Address*
Home Phone*
Cell Phone
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Student Information
Student Name
First Last
Student DOB
Select Campus*
Preferred Day
Select Preferred Time*
Please indicate the day/time for (2nd preference)
Name of instrument your child plays or wishes to play.*
Has Your Child Been Taking Lessons?*
- YES
- NO
If YES, how many years?
Please describe any goals you have for your child.

Parent Information