JUBAL’S MUSIC CENTER

REGISTRATION FORM

Name: ______________________________________________________________________
(First Name) (Middle Initial) (Last Name)
Nickname: _______________________________________

Birthday: _______________________________ Age: ________________

School: ______________________________________ Grade Level: ____________________

Address: ____________________________________________________________________

Mobile Number: ______________________________

Name of Parent/Guardian: _____________________________________________________

Parents’/Guardian’s Contact Number: __________________________________________

Enrolling for (Please check () one):

[ ] Piano Lesson [ ] Guitar Lesson [ ] Violin Lesson

[ ] Drum Lesson [ ] Voice Lesson

SCHEDULE:
Lesson Day/s: ____________________________________
Time: ___________________________________________

_________________________________________________
STUDENTS’ SIGNATURE

_________________________________________________
PARENTS’/GUARDIAN’S SIGNATURE

DATE: _____________