RIVERCITY ROCKERS (12-18) REGISTRATION

 

To enroll in our Rockers Program at RiverCity Rock Star Academy, complete the registration form below -- space is limited!

Parent Name *
Parent Name
Phone *
Phone
Address
Address
Please include names, email addresses and phone numbers
Student Name *
Student Name
Date of Birth *
Date of Birth
Grade
Instrument(s) *
You may select as many as appropriate. For other please provide more information in the musical experience comment area.
Please indicate the amount of experience with the instrument(s) you selected above.
Please provide more information about your musical experience, education and training.
Select your billing frequency plan
Select (Adult Men's or Women's) Pre-Shrunk Cotton
If you indicated in the previous question that you were referred by a person or a business, please provide their name so we can thank them for their referral.
Any other additional comments or information that you would like to share.