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Homeschool Classes Registration Form
Senseney Music, Inc.
2300 E Lincoln, Wichita, KS 67211
Contact us at 316-262-1487 or adavis@senseneymusic.com
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* Indicates required question
Email
*
Your email
Student Name
*
Your answer
Birthdate
*
MM
/
DD
/
YYYY
Age
*
Your answer
Student Email
Your answer
Student Phone
Your answer
Instrument
*
Flute
Clarinet
Alto Saxophone
Trumpet
Trombone
French Horn
Baritone
Tuba
Percussion
Violin
Viola
Cello
Other
Which class are you registering for?
*
Beginning Band Thursdays 11:30pm
2nd Year Band Thursdays 12:30pm
Intermediate Band Thursdays 1:30pm
Beginning Strings Mondays 10am
2nd Year Strings Mondays11am
Jazz Band Tuesdays 11am
Ukulele Wednesdays 12:30 (starting in October)
Recorder Thursdays 10:30am
Required
Parent/Guardian Name(s)
*
Your answer
Parent/Guardian Phone
*
Your answer
Parent/Guardian Email
*
Your answer
Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip
*
Your answer
Agreement Form
*
I agree (Signature)
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A copy of your responses will be emailed to the address you provided.
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