SCHOOL OF MUSIC REGISTRATION FORM
Note: highlight and print this form - mail or bring completed form to First Baptist Church, 12716 Warwick Boulevard Newport News VA 23606
I wish to be enrolled in the School of Music.
NAME OF STUDENT: ___________________________________________________
COMPLETE MAILING ADDRESS: _________________________________________
_________________________________________
E-MAIL ADDRESS:______________________________________________________
INSTRUMENT(S) DESIRED: ______________________________________
AGE: ________ YRS. OF EXPERIENCE: ______ HOME PHONE: _______________
DATE OF BIRTH: __________________________ CELL PHONE: ________________
PARENT'S DAYTIME PHONE NUMBER: ____________________________________
In the event parent cannot be reached call:___________________________________
relationship:____________________ phone: ________________________________
1. ____ I would like to be enrolled in the
2. ____Registration fee of $25 is enclosed. Make checks payable to First Baptist Church.
3. The best day of the week for my lesson is _________________. I could, however, have my lesson on one of the following days: _________________, ____________________, or ______________________.
4. The best time of the day for my lesson is __________________. I could, however, have my lesson at any one of the following times: ________________, _________________, or ____________________.
5. I would prefer to study with _______________________________. (name of teacher)
6. I am a returning student of ________________________________. (name of teacher)
7. I am a new student in the
8. I would like to enroll in Kindermusik. ________
9. Today’s date _______________________.
SIGNATURE OF PARENT(S) - if applicable __________________________
(For office use only)
Date Received_______________ Lesson day and time ____________________
Instructor___________________ Instrument ____________________________
