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 

 

Instrument 

 

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.