EMU Community Music Academy Fall 2018 Keyboard Games Class Registration
10-week class session runs Mon Oct 8-Mon Dec 10, 2018 (5:30-6:15pm)
Email address *
Instructions:
Registering is a two-step process:
1) Select the course or courses from the list for which you wish to register and complete the form below. (Please submit separate forms for each student.)
2) Bring cash or a check written out to "EMU" to your first class. Registration is not complete until payment has been received.
Which class would you like to register for?
Do you qualify for a discount?
Student Name (first & last)
Your answer
Student Birthdate
Your answer
History of musical experiences:
Your answer
Musical goals:
Your answer
Does the student have any special circumstances of which the EMU CMA staff should be made aware?
Your answer
CONTACT INFORMATION FOR PARENTS/GUARDIANS
Parent/Guardian 1 Name (first & last)
Your answer
Parent/Guardian 1 Email Address
Your answer
Parent/Guardian 1 Mailing Address (street, city, state, zip)
Your answer
Parent/Guardian 1 Phone Number
Your answer
Parent/Guardian 1 Alternate Phone (if applicable)
Your answer
Parent/Guardian 2 Name (first & last)
Your answer
Parent/Guardian 2 Email Address
Your answer
Parent/Guardian 2 Phone
Your answer
Referral Information: How did you hear about us?
Your answer
A copy of your responses will be emailed to the address you provided.
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