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Please print this page and mail
with your payment.
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Student’s name & age_______________
Parents’ names____________________
Address__________________________
__________________________
Home &
Cell Phone________________________
Emergency contact 1st choice home or cell
phone___________________________
E-mail___________________________
Anything we should know about: ________________________________
Class enrolling in:__________________
Instrument: ______________________
Check one:
__ Private Lessons -contact James Robinson
__ $25 registration/music supply fee enclosed.
(Beginner
Band & Recorder Students)
__ $40 registration/music supply fee enclosed.
(Intermediate
Band Students)
__ $50 registration/music supply fee enclosed.
(Advanced Band Students)
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