Prairie Music & Arts Group Music Registration Form
Use this registration form for the following classes & programs: Early Childhood Music, Friends at the Piano, and S.I.N.G.
Last Name of Student *
Your answer
First Name of Student *
Your answer
Home Phone *
Your answer
Parent #1 First & Last Name *
Your answer
Parent #1 Phone (Cell Phone) *
Your answer
Parent #2 First & Last Name
Your answer
Parent #2 Phone (Cell Phone)
Your answer
Email Address - Please list all addresses you check most frequently in order to maintain regular communication with PMA. *
Your answer
Student's Date of Birth *
MM
/
DD
/
YYYY
Student's Age/Grade in Fall *
School Attending
Your answer
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