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MOYER
MUSIC STUDIO
REGISTRATION
FORM (one per child)TODAY'S
DATE:_______________________
How
did you hear about our music classes/lessons?
Web
page_____ flyer______ mailing______friend______0ther________(please specify)
STUDENT
INFORMATION
Child's
Name____________________________________
Child's
Age (as of first day of class)________ Date of Birth:__________
Parents'
Name(s)___________________________________________
Address:_________________________________________________
City,
State, Zip Code________________________________________
Phone:____________________
Email:_________________________
Cell Phone:___________________________________________
Please
write any information here that you feel is important for the teacher
to know:___________________________________________
CLASS
INFORMATION
Class
Name: SUMMER: Blast Off with Piano Class #1_____ #2_____ #3_____ #4_____ #5______ (please check one)
*
If you would like to be placed in a class with a friend or relative,
write their name here. We will do our best to honor
requests._______________________________
Tution
Total $125.00 per child
Please
make checks payable to Wendy Moyer
Thank
you for your registration. We will confirm your registration via
phone or email.
Moyer
Music Studio 2890 W Owasso Blvd Roseville, MN 55113
651-293-6396 www.wendyspiano.com wendy@pmoyer.org
MEDIA
RELEASE
I
give permissions for my child's and any caregiver's/observer's images
to be used in any Moyer Music Studio publications, promotional
materials, videos, slide shows, and the Moyer Music Studio website.
Parent Signature___________________________________________Date____________