HBBC SCHOOL OF MUSIC REGISTRATION

Student's Name *

First Name

Last Name

Student's Date of Birth *

MM

DD

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent's Name (For students under 18 years old)

First Name

Last Name

Parent's Cell Phone (For students under 18 years old)

(###)

###

####

Student's Cell Phone (Adult students only)

(###)

###

####

Best Day for Lessons (Please select each day that you are available) *

Monday

Tuesday

Wednesday

Thursday

Best Time Range for Lessons (Please select each day that you are available) *

2pm - 3pm

3pm - 4pm

4pm - 5pm

5pm - 6pm