Home Registration

Date:

Parent's full name:

Referred by?

Found us how?

Found us how? Phone book Internet Referral

Drum set in home?

Drum set in home? Yes No

Are there smokers in the household?

Smokers in the household? Yes No

Information below applies to the student only.

Full Name:

E-mail:

Student's age:

Age: Adult 20 19 18 17 16 15 14 13 12 11 10 9 8 7

Student's school:

School: Not in school Home school Pre-school Elementary school Middle school High school College

Gender:

Gender: Male Female

Home address:

City, State, Zip:

Home phone (example: 555-555-5555)

Cell phone (example: 555-555-5555)

Work phone (example: 555-555-5555)

Teacher:

Teacher: Larry Bennett

Tuition rate:

Tuition rate: $85 - single one hour lesson $300 - four week month $375 - five week month

Starting month:

Starting month: January February March April May June July August September October November December

Starting week:

Starting week: ASAP 1st week of month 2nd week of month 3rd week of month 4th week of month 5th week of month

Available from:

Available from: 9 am through 9:30 am through 10 am through 10:30 am through 11 am through

To:

To: Monday - Friday 10 am 10:30 am 11 am 11:30 am 12 pm

On days:

On days: Sunday Monday Tuesday Wednesday Thursday Friday

Cash?

Cash? Yes No

Check number:

Registration_fee

Registration fee: $0.00 (One-time lesson) $20.00 (New student 4-5 week month)

Total amount:

How I will send tuition:

How I will send tuition: Zelle (Submit tuition using 303-402-1500) Check

I understand that the tuition must be received at least three days in advance of each single lesson or monthly program.

I agree with the enrollment policies.   

Message:

Message:

Enter captcha numbers here:

 

Send

If you haven't already contacted the Boulder Drum Studio to discuss the day and time for your lesson, a representative will contact you after receiving this form.  Thank you.

No person shall be discriminated against in any term, condition, or privilege because of race, creed, color, gender, sexual orientation, marital status, religion, national origin, ancestry, age, mental or physical disability.  The Boulder Drum Studio does not discriminate in the administration of its educational policies, admissions policies and educational programs and activities.