Georgia Center for the ArtsMeet the Teachers → Registration Form

2010-11 Online Registration for Private Lessons
Note: Please fill out a separate form for each sibling in the same family
  
I'd like someone to contact me for available teachers and times: I'm ready to register online and pay the registration fee:

PLEASE CONTACT ME FOR TEACHER INFORMATION
Name:
Email:
Phone number:
Instrument:
Preferred teacher(s):
(leave blank if no preference)
Preferred days and times of the week:
 

ONLINE REGISTRATION
Student Name: Student Email:
Student Home Phone: Student Cell Phone:
Student School: Grade Level:
 
SUPPLEMENTAL INFORMATION
Parent/Guardian Name: Parent/Guardian Address:
Parent/Guardian City/State/Zip: Parent/Guardian Cell Phone:
 
HEALTH INFORMATION
Physician Name: Physician Telephone:
Emergency Contact Name: Relationship to Student:
Emergency Contact Number: Special Medical Needs:
       
LESSON DETAILS
Instrument:
Preferred teacher(s):
(leave blank if no preference)
Preferred days and times of the week:

 

 Policies & Procedures

To receive information regarding scheduling, rates, and other information, please contact the Cobb Symphony at info@cobbsymphony.org.

Cobb Symphony Orchestra | Murray Arts Center at Mount Paran Christian School | 2250 Stilesboro Road | Kennesaw, Georgia 30152
Phone: 770-429-7016 | Fax: 770-794-8916 | © 2010 Cobb Symphony Orchestra | webmaster