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Prairie Music & Arts Group Music Registration Form
Use this registration form for the following classes & programs: Friends at the Piano, First Steps in Music, and S.I.N.G.
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* Indicates required question
Last Name of Student
*
Your answer
First Name of Student
*
Your answer
Home Phone
*
Your answer
Parent #1 First & Last Name
*
Your answer
Parent #1 Phone (Cell Phone)
*
Your answer
Parent #2 First & Last Name
Your answer
Parent #2 Phone (Cell Phone)
Your answer
Email Address - Please list all addresses you check most frequently in order to maintain regular communication with PMA.
*
Your answer
Student's Date of Birth
*
MM
/
DD
/
YYYY
Student's Age/Grade in Fall
*
Choose
Age 0-2.5
Age 3-4
Age 4-5
4K
K
1
2
3
4
5
School Attending
Your answer
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