“Pure Imagination” Series Registration Form

Student Name*First Name

Last Name

Gender*

Date of Birth*Please use format MM/DD/YYYY

Student’s Email Address (optional)If you would like class reminders & materials to also be sent to your student

Student’s Phone Number (optional)If you would like class reminders & materials to also be sent to your student

Desired Courses (please select all that apply)

Musical Composition I

Musical Composition II

Musical Composition III

Musical Arrangements I

Musical Arrangements II

Musical Arrangements III

Music Transcription I

Music Transcription II

Music Transcription III

Music Production I

Music Production II

Music Production III

Music Performance I

Music Performance II

Music Performance III

Additional NotesPlease use this space to add any additional notes re: scheduling.

Parent/Guardian (main contact)*First Name

Last Name

Email Address*

Phone Number*

Additional Parent/Guardian (optional)First Name

Last Name

Email Address

Phone Number

Message (optional)Please use this space to add any questions or comments.

Acceptance of Rates & Terms*I agree to the rates/terms for this special program as provided to me via email. I understand that to complete my registration and reserve my child’s spot, payment will be submitted along with this registration form.

View Media ReleaseAcceptance of Media Release (optional)I have read and accept the terms of the Music 4 Kidz Media Release Form.

Parent/Guardian Signature*By typing my full name, I consider this to be my legal signature that the above information is accurate.

Pure Imagination Series – Registration Form

Please complete the form below to register your student for Musical Composition, Musical Arrangements, Music Transcription, Music Production, and/or Music Performance.

Available Spots are first come, first served. Please CLICK HERE to learn more about our Pure Imagination courses!