Summer Registration Form, Academy of the Arts, UA Fort Smith

Summer Registration Form

If student is under 18 years old
Student's Name*
Address*
City*
State*		Zip*
Home phone*
Work Phone*	Phone number is for: Parent Guardian Student
Cell Phone	Phone number is for: Parent Guardian Student
Email
Date of Birth*

School
Grade
Parent/Guardian name(s)*
Parent/Guardian Email

Private Music Instruction (Your instructor will call you to arrange your lesson time.)
Instrument*	Piano Voice Flute Guitar Percussion
Choose 4, 6, or 8 weeks of lessons for 30, 45, or 60 minutes each week.*
4 Weeks 6 Weeks 8 Weeks	30 Minutes 45 Minutes 60 Minutes

* Denotes a required field.

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