Homeschool Music Class Registration Form
For the Homeschool Music Class with Daniel Mockenhaupt (Level 2) or Laura Kausek (Level 1).

Level 1: Thursdays 2:30-3:15pm, starting January 11, 2018.
Level 2: Wednesdays 10:00-10:45am, starting January 10, 2018.

$80 for a 10-week Session.

Payment in entirety is due on the first day of class unless prior arrangements have been made with the Director. We can also bill EPIC.

Location: Imagine Music and Arts, 800 W Rock Creek Rd. #121, Norman

Student Last Name *
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Student First Name *
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Parent Name(s) *
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Address *
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Phone Number (most used) *
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Additional Phone Number (in case of emergency) *
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Parent Email Address *
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Student's Birthdate *
MM
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DD
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YYYY
Student School (or Homeschool)
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Student Grade *
Has the student taken music lessons or classes before? If so, when, and what were they? *
Your answer
What level are you registering for? (Choose 1 if no music experience) *
Please list any special needs, learning or behavior disabilities, or dietary restrictions.
Your answer
Other activities the student participates in: *
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Student or parent goals, wishes, hopes, dreams, desires for music class: *
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Please bill EPIC for my tuition. *
Additional comments or questions for us:
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