Youth Registration Form
Dates: Thursdays, March 16th - May 4th, 2017, 4:00pm -5:30pm
Address: 2751 West Broadway, Eagle Rock, 90041
Contact us at (323) 259-3011 or scorchestra@gmail.com
Student's First Name
Your answer
Last Name
Your answer
Email
Your answer
Cell Phone #
Your answer
Street Address
Your answer
City
Your answer
Zip Code
Your answer
Age
Your answer
Instrument
Your answer
How long have you played your Instrument?
Your answer
Do you take private lessons?
Required
Music Teacher's Name
Your answer
Name of School you Attend
Your answer
Grade
Your answer
Parent's Name
Your answer
Parent's Phone #
Your answer
Submit
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