Anona United Methodist Church
Friday, May 18, 2012

Registration Request

Complete our on-line registration form below or click HERE to download a copy.

* indicates required item

*Student Name:
Gender: Male              Female
  Adult             Child
Age: (children only)
Date of Birth: (children only)
Grade: (children only)
School Attending: (children only)
*Parent/Guardian: (children only)
Mailing Address:
Bill to Address:
(If different than mailing address)
*Home Phone:
Work Phone:
Cell Phone:
*Email:


In Anona Preschool/After Care Program? Yes        No
(if YES, please sign release at the Pre-School/After-Care Office for lessons/classes during the time your child is at the Pre-School/Aftercare Program)


Private Music Instruction
Instrument:
Skill Level: Beginner        Intermediate         Advanced
Have Instrument? Yes             No
Day & Time Preferences: (3 best times for class/lesson)
1st:
2nd:
3rd:
   
Message: