Student Database Information Form

Please fill out the following information form so we can add you to our CHARMs database.

Student ID Number

Student First Name

Student Middle Name

Student Last Name

Grade

Birthdate

YYYY

Sex

Instrument

Address

City

Zip Code

Student Home Phone Number

(###)

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Student Cell Phone Number

(###)

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Student E-Mail Address

T-Shirt Size

Are you taking private lessons?

YES

NO, but I am interested in starting.

If you are taking lessons, who is your teacher?

ADULT 1 INFORMATION

Adult 1 First Name

Adult 1 Last Name

Adult 1 Address

Adult 1 City

Adult 1 Zip Code

Adult 1 Work Phone Number

(###)

###

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Adult 1 Home Phone Number

(###)

###

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Adult 1 Cell Phone Number

(###)

###

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Adult 1 E-Mail Address

Adult 1 Occupation

ADULT 2 INFORMATION

Adult 2 First Name

Adult 2 Last Name

Adult 2 Address

Adult 2 City

Adult 2 Zip Code

Adult 2 Work Phone Number

(###)

###

####

Adult 2 Home Phone Number

(###)

###

####

Adult 2 Cell Phone Number

(###)

###

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Adult 2 E-Mail Address

Adult 2 Occupation

Student Database Information Form

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