Registration - Susquehanna Strings

Student Name

Age

Parent/Guardian(s)

Home Phone Number

Work Phone Number

Best Time of Day to Call

E-mail Address

Street Address

City

State

Zip Code

Relationship to Child

School Presently Attending

Grade

School Music Teacher

Instrument:

Years on Instrument:

Have you studied in the program before? *

	I am a new student in the Preparatory Program
	I have studied in the Preparatory Program

Enrollment:

	Enroll for the fall & spring semester (recommended). Fee: $70
	Enroll for the present semester. Fee: $40

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514 University Avenue

Selinsgrove, PA, 17870 United States