15600 OLD ROCKFORD RD., PLYMOUTH, MN 55446 • MAP • E-MAIL • CHURCH: (763) 553-1239 • SBCA: (763) 553-3083

SBCA REGISTRATION: MUSIC
Summer, 2011: Monday, June 13 - Saturday, August 13

For the summer, we offer flexible numbers of lessons because of vacations and other summer activities.

STUDENT INFORMATION - The Student

NAME:

Last Name

First Name

GENDER/DATE OF BIRTH:

Male Female

DOB:

COURSE OF STUDY

LESSON/SESSION LENGTH:

30 45 60 <- choose this for Hour-Long PRIVATE LESSONS, FIDDLE CLASS, BRASS QUINTET or HORN ENSEMBLES 120 <- choose this for STRING IT TOGETHER

CLASS/ENSEMBLE SIZE:

2 3 4 5
For HORN TRIO or FIDDLE CLASS, select 3; for HORN QUARTET, select 4; for BRASS QUINTET, select 5. No need to fill this in if you're registering for a PRIVATE LESSON or for STRING IT TOGETHER

LESSONS DESIRED:

Up to 10 lessons available for private students of Ms. Berman. For other private lessons, please select anywhere 4-9.
HORN TRIO and HORN QUARTET STUDENTS please select 6. FIDDLE CLASS STUDENTS please select 7. STRING IT TOGETHER STUDENTS please select 11.

COMMENTS:

PRIOR STUDY:

Number of years of prior study in this course

BILLING INFORMATION - Person paying the tuition.

NAME:

Last Name

First Name

STREET/APT:

Street

Apt

CITY/STATE/ZIP:

City

State

ZIP

HOME PHONE:

WORK PHONE:

CELL PHONE:

E-MAIL:

MEMBER:

Yes No
Member of St. Barnabas? (Used for statistical purposes only)