SATURDAY MUSIC & ARTS

UNIV. KID's SATURDAY MUSIC & ARTS

Registration/Application Form - Classes begin October 7th, 2017
Child's Name

First Name Last Name
Childs Date of Birth

- Month - Day Year
Date
What Musical Instrument or Art form would like to learn? You can pick more than one. *

Djembe Drum Cartooning Trumpet Piano Painting Drama Singing/Chorus Sculpting Other option
Parents Name

First Name Last Name

Primary Home Address

Secondary Home Address

Mom's Phone Number

- Area Code Phone Number
Mom's Email:
example@example.com
Dad's Phone Number

- Area Code Phone Number
Dad's Email:
example@example.com
EMERGENCY CONTACT INFO.
Emergency Contact:

First Name Last Name
Emergency Contact Phone #:

- Area Code Phone Number
Please use this space below to submit additional names, phone #'s of responsible family & friends for Emergency contact!
Please # 1,2,3,4, etc. for the additional family members for emergency contact.
PAYMENT PORTAL

Tuition Payments

Saturday Music & Arts Registration $ 25.00

Monthly Tuition Payment $ 175.00

Quantity
Item subtotal: $ 0.00

Total: $ 0.00

UNIV. KID's SATURDAY MUSIC & ARTS