Music Registration
Piano
Guitar
Bass
Drums
Ukulele
Beginner Banjo
Beginner Mandolin
Violin - Thursday only
Vocals - Thursday only
Email *
Student Name *
Age *
Instrument *
Preferred Day of the week - Day of the week will depend on availability. Once registration is received KPAC staff will contact you to confirm day and time *
Preferred Time between 2:30 pm-8:30 pm-Lesson time will depend on availability. Once registration is received KPAC staff will contact you to confirm day and time *
Time
:
Birthday
MM
/
DD
/
YYYY
Mom Name
Dad Name
Custody Arrangement
Address - Please include your postal code *
Phone *
Email *
Emergency Contact : Name & Phone *
Relationship to Student
Allergies or Medical Conditions
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