ROCK BAND Registration Form: WAG Music

ROCK BAND: Registration (Weary Arts Group)

(We encourage all students to study privately with a teacher to best benefit from the ROCK BAND Ensemble Experience)
Name

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number *

Area Code Phone Number
E-mail *
Gender

Male Female Other
Birth Date

Month Day Year
School Attending:
Instrument(s) you are proficient in:

Vocals/Singing Electric Guitar Acoustic Guitar Bass Guitar Keyboards Ukulele Mandolin
Do you study PRIVATELY with a teacher? If so, what instrument, and who is your teacher?
Parental/Guardian Information
Parent/Guardian

First Name Last Name
Parent/Guardian

First Name Last Name
Relationship to the student
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
E-mail
example@example.com
Cellphone Number

Area Code Phone Number
Should be Empty:

ROCK BAND: Registration (Weary Arts Group)