Fall After-School Registration Form

Child's name *
Child's name
Please choose your day *
Monday - Wednesday location is at Mackenzie Adult Building, Mackenzie Park. Tuesday Rock Band Photography/Film making location is at Mackenzie Adult Building, Mackenzie Park. Wednesday Rock Band Photography/Film making location is at Mackenzie Adult Building, Mackenzie Park. Tuesday Girls Rock Pop Rock Choir location is at Santa Barbara Jr. High, Room 123. Thursday Pop Rock Choir for teens at Santa Barbara Jr. High Room 123 Ttuesday (Amplify Teen Program) location is at Santa Barbara Jr. High, Room 123
We try and give everyone their first choice instrument, but it is not always possible.
DOB *
DOB
Address *
Address
Name of parent / guardian *
Name of parent / guardian
Preferred contact number *
Preferred contact number
How are you paying? *
Payment is due the first day of session.
Name on credit card *
Name on credit card
First emergency contact *
First emergency contact
Contact number *
Contact number