Tabernacle Baptist Church
Wednesday, October 22, 2014
School of the Arts at Tabernacle
Application / Registration Form
Student's Name 
Street Address 
City       State       Zip 
Home Phone #                       Birth Date 
Student's School       Grade 
If student is living with parent(s) or guardian, please complete the following:
Parent(s) Name 
Cell / Business Phone # 
Day of week preferred:     1st Choice 
                                           2nd Choice  
Time of day preferred:      1st Choice 
                                           2nd Choice 
How many years of instruction have you had for this instrument?     Years     Beginner? 
Is the Student a member of Tabernacle?      Yes     No
If not, where do you attend church? 
Email Address: 
Preferred Teacher: 
As Parent / Guardian for the above student I / we accept the responsibility for the attendance at each lesson.  I understand that I, or another adult will accompany my child to each private lesson.  I further understand that unexcused absences will be paid at the stated price without a make-up lesson.  The non-refundable registration fee of $20 per student for the first semester must be submitted to Mrs. Arlene Shook before this registration can be accepted.  Make checks payable to Tabernacle Baptist Church.