COMMUNITY MUSIC SCHOOL - REGISTRATION FORM

Personal Information

Student

Email

Street Address

City

State

Zip

Home Phone

Cell Phone

Age (if minor)

Birthdate (if minor)

Name of Responsible parent or guardian

Continuing Student

New Student

Private Instruction:

Teacher's Name

Instrument

Length of Lesson

Day and Time of Lesson

Classes and Ensembles:

Please list Class Title / Day and Time of Class / Tuition in the textfield below