UMC Discovering Music Program - 2019 Winter/Spring Semester - Student Sign Up
Please fill out this form to get your student signed up in the UMC Discovering Music program. This provides us basic contact information for communication purposes. All this information is held privately by our Admissions and Enrollment Director.
First and Last Name of Student: *
Your answer
First and Last Name of Parent/Guardian: *
Your answer
Student Gender: *
Student's Date of Birth: (MM/DD/YR) *
MM
/
DD
/
YYYY
Student's Current Age: *
Your answer
Student's Address *
Please list the student's primary address. Ex:144 West Third Street, Williamsport, PA 17701
Your answer
Home Phone #: *
Please include area code. Ex:000-000-0000
Your answer
Parent's Cell Phone #: *
Please include area code. Ex:000-000-0000
Your answer
Parent's Primary Email Address: *
Email address that is checked the most often.
Your answer
What school does the student attend? (If applicable)
Your answer
Which UMC Discovering Music class are you signing up for? *
Does the student have any previous experience with music? *
Your answer
Does the student have any health issues that we need to be aware of? *
Ex: Allergies, medical conditions, learning disabilities, etc.
Your answer
I hereby give my consent to the Uptown Music Collective to use photos and videos (including live streams) of my child for publicity and promotional purposes. *
Questions or Comments?
Please list and questions you might have and they will be answered in the Admission and Enrollment Director's response.
Your answer
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This form was created inside of Uptown Music Collective.