Spring 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 PopRock Choir location is at Santa Barbara Jr. High, Room 123. Thursday (Amplify) 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