Academy Registration

Registration

Student Information
Student Name *
Student Name
Student Date of Birth *
Student Date of Birth
Student Address *
Student Address
Primary Phone *
Primary Phone
Secondary Phone
Secondary Phone
Parent/Guardian *
Parent/Guardian
Alternate Parent/Guardian
Alternate Parent/Guardian
If student will be picked up or dropped off by more than one person, please put name below.
Class Selection
Please select the type of class you wish to take
We will contact you to schedule the specific lesson time
We will contact you to schedule the specific lesson time
We will contact you to schedule the specific lesson time
We will contact you with specific group lesson time
Will be offered at a later date
We will contact you with specific group lesson time
Music classes for the Pritchard Child Development Center