Student Registration Form
Harmony Music School Student Registration Form
Semester/Year
Student Name *
Your answer
Sex *
Date of Birth *
MM
/
DD
/
YYYY
Age *
Your answer
Parent(s)/Guardian(s) Name *
Your answer
Address (Street, City, State, Zip) *
Your answer
Email Address *
Your answer
School *
Your answer
Grade *
Your answer
Parent/Guardian Home Phone Number *
Your answer
Parent/Guardian Cell Phone Number *
Your answer
Alternate Contact Name *
Your answer
Alternate Contact Phone Number *
Your answer
Who does the youth live with? *
Siblings at Harmony Music School (please indicate instrument): *
Your answer
Does the student have any allergies or use medications? If yes, please list below: *
Your answer
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