Karen Haughey Music Studio 

Music Makers: At the Keyboard III- winter/spring 2018 registration

Graduates of Keyboard II. 27 week session

*= required information

Child's Name *
Child's Name
Child's Birthdate *
Child's Birthdate
Siblings
Optional
Sibling 1
Sibling 1
Birthdate
Birthdate
Sibling 2
Sibling 2
Birthdate
Birthdate
Parents, Guardians and Care Takers.
Parent/Guardian 1 *
Parent/Guardian 1
Phone *
Phone
Alt. Phone
Alt. Phone
Optional
Address *
Address
Parent/Guardian 2
Parent/Guardian 2
Optional
Phone
Phone
Caretaker or other adult accompanying child to class
Caretaker or other adult accompanying child to class
Required information if child will not be accompanied by a parent or guardian.
Phone
Phone
Additional Information