Fall 2007
Grace
Notes
Academy – Private Piano Lessons
Registration Form
Student Name |
Grade Level |
Birthday |
|
|
|
|
|
|
|
|
|
|
|
|
Address ____________________________________________________________________
City ___________________ Zip Code ____________ Home Phone _________________
Parents’ Names ______________________________________________________________
Emergency Contact _________________________ Relationship ________ Ph. # _______
Parent’s Cell Phone Numbers or Work Numbers
____________________________________________________________________________
(I need to know emergency numbers and such in case of emergency during the lesson!)
E-Mail Address: _____________________________________________________________
(Your e-mail address will be kept confidential. I will not give it to anyone else or forward anything to you that does not directly pertain to piano lessons!)
Please return this form, along with the $20 per student supply fee (not to exceed $45 per family) (checks made payable to Marie Cole), to:
Marie Cole
369 Bradfield Drive
Buda, TX
78610
| 