Parent/Guardian Name *

This is the parent/guardian who will do most of the communication regarding lessons.

First Name

Last Name

Phone *

(###)

###

####

Additional Parent/Guardian Name

This is anyone else who would like to be on the email list for routine studio reminders or who will also be dropping off/picking up students from lessons.

First Name

Last Name

Additional Parent/Guardian Phone

(###)

###

####

Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Student #1 Name *

First Name

Last Name

Student #1 Birthday

MM

DD

YYYY

Student #2 Name

First Name

Last Name

Student #2 Birthday

MM

DD

YYYY