Registration Form
Please complete the information requtested below and return this page to me. Your date of birth
and grade are required for participation in several music events.
Student’s Name: ______________________________________
Parent’s Name’s: ______________________(mom) ______________________(dad)
Date of Birth: ___________________ Years of Lessons:________________
Prior Teacher(s) ____________________________________________________
Grade: ____________ School _____________________________________
Street: ____________________________________________________________
City, State, Zip ____________________________ _______________ ________
E-Mail: ___________________________________________________________
Phone: (home) ________________________ (work)_______________________
(cell) __________________________ (fax) ________________________
Start Date at Barbara Taylor Music Studio: ___________________________
TO BE SIGNED BY STUDENT or PARENT as applicable:
I have read and understand the Barbara Taylor Music Studio Letter on the prior page and will
ensure that they are followed. I further understand that Barbara Taylor has the right to terminate
lessons should any of the policies be broken and discussions do not lead to the desired and on-
going agreed to action(s) or behaviors.
Signature: _________________________________________
Date: ______________________________
Briefly state your musical goals (Use reverse side of paper, if necessary):
Please complete the information requtested below and return this page to me. Your date of birth
and grade are required for participation in several music events.
Student’s Name: ______________________________________
Parent’s Name’s: ______________________(mom) ______________________(dad)
Date of Birth: ___________________ Years of Lessons:________________
Prior Teacher(s) ____________________________________________________
Grade: ____________ School _____________________________________
Street: ____________________________________________________________
City, State, Zip ____________________________ _______________ ________
E-Mail: ___________________________________________________________
Phone: (home) ________________________ (work)_______________________
(cell) __________________________ (fax) ________________________
Start Date at Barbara Taylor Music Studio: ___________________________
TO BE SIGNED BY STUDENT or PARENT as applicable:
I have read and understand the Barbara Taylor Music Studio Letter on the prior page and will
ensure that they are followed. I further understand that Barbara Taylor has the right to terminate
lessons should any of the policies be broken and discussions do not lead to the desired and on-
going agreed to action(s) or behaviors.
Signature: _________________________________________
Date: ______________________________
Briefly state your musical goals (Use reverse side of paper, if necessary):
The Barbara Taylor Music Studio
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