Hello 6VibeZ Student!

Before filling out the registration form below, please read and get familiar with the 6VibeZ Regulations.

Thank you for becoming a member of our music family!

Registration Form

Name of Student: *

First

Last

Date of Birth:

mm/dd/YYYY

Instrument choice: *GuitarGuitarUkuleleFluteViolinViolaCelloPianoPercussions/DrumsOther

Lesson type: *

• Private
• Group/Shared
• Ensemble

Enrolled in: *

• 30 minutes
• 45 minutes
• 1 hour

Name of Parent/s: *

If not applicable, type: N/A.

Address (Street, City, Zip): *

Phone: *

Email: *

Payments made per: *

• Month
• Semester

*Please make check payments payable to: 6VibeZ Music Inc.

I hereby grant the 6VibeZ Music Inc. permission to use my/my child’s likeness in a photograph, video, or other digital media in any and all of its publications, including web-based publications, without payment or other consideration: *

• Yes
• No

I have read and agree to the above terms and conditions: *

First

Last

Submit