Winter/Spring 2020 Registration

Semester Dates: Jan 6th - June 7th

Lesson Days: Tuesday-Saturday

Student Name

First Name

Last Name

Sibling Name (if applicable)

First Name

Last Name

Parent Name

First Name

Last Name

Home Phone Number

Mobile Phone Number

(###)

###

####

Email Address

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Student Date of Birth

MM

DD

YYYY

Sibling Date of Birth

MM

DD

YYYY

Emergency Contact

First Name

Last Name

Emergency Contact Phone Number

(###)

###

####

Student Lesson

Sibling Lesson

Student Previous Experience (if any)

What is your preferred lesson day and time?

Choose a Payment Option

Please read and make sure you agree with DewMusic Studio's Lesson Policy

I have read and agree to the terms and conditions outlined in the Lesson Policy

I agree

After you submit this registration form, someone from DewMusic Studio will contact you via the email address you provided regarding method of payment. If you have any questions or concerns, please email us at dewmusicstudio@gmail.com. Thank you!

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