REGISTRATION FORM
Student name:
Date of birth:
/
/
Address:
Day school:
Medical information (allergies, etc.):
Parent/Guardian 1
Name:
Cell:
Email:
Parent/Guardian 2
Name:
Cell:
Email:
Instrument:
piano
guitar
drums
voice
bass
band
toddlers
music theory
Lesson duration:
30 mins
45 mins
60 mins
not sure
Preferred day (choose 2 at minimum):
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
How did you hear about DCAM? Check the applicable box:
google search
facebook
instagram
youtube
humbertown sign
friend or relative
other (please specify):
Submit registration