Students Name:

Male

Female

Age

Students Date of Birth:

*Ethnic background: White     Black    Hispanic    Native American    Asian     other  

*Any disabilities or special attention your child may need: (explain)


Parents Name:

Address:

City:    State:     Zip Code:

Email:

Phone Numbers:

Home:   Cellular:

Work: (Check main contact number)

Previous Enrollment Information

What dates did your child attend?      From:   To:

SoBE Music Institute? Yes No

What Instrument?

Group Classes or Private Lessons?

If not does child have any previous music experience? Please Explain


Enrollment Information

1st Choice Instrument (pick one) violin cello flute oboe trumpet guitar piano saxophone

2nd Choice Instrument (pick one) violin cello flute oboe trumpet guitar piano saxophone

Other



In signing this form, I acknowledge that failure to disclose and submit accurate information may result in denial of admission to the institute I certify that all information provided is complete and true.

Signature:                     Date:


Printed Name: