KIDS
ROCK FREE© Student
Application Form
Applicants
Full Name:___________________________
Age:____
Parent's
Name if minor:__________________________
Applicants
Date of Birth:___________
Mailing
Address:_______________________________
City:_______________
State:________
Zip:_________
Phone
Number: Daytime: (____) ________ Evening: (____) ________ Fax: (____) ________
Email:________________________
Parents
Employment Information: (Optional) This information may be used for future
Kids Rock Free© educational program funding.
Father's
Employer:_________________________
Mother's
Employer:________________________
Employer's
Address:___________________________________
Employer's
Address:___________________________________
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Applicant Attends: Public School - Private School -
Home School - N/A
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| Performing Arts Course
Interested In: (Circle One)
GUITAR BASS PIANO
DRUMS VIOLIN VOICE
JAMNASIUM – (Old-Guy-Jam-Night) DANCE DRAMA BRASS WOODWIND
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| Level of Applicant: (Circle One) Beginning - Intermediate - Advanced |
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Not all Classes are offered each quarter. Courses will be added, as funding
becomes available.
- All Applicants are chosen on a first-come, first-served basis.
- Most courses will be held at the Fender Museum of Music and The Arts Preview
and Education Center located at 365 North Main --Street,
Corona.
- All Performing Arts Courses are being offered free-of-charge for the *first
2 sessions (16 weeks.) This is made possible through the --generous
--financial and in-kind support of the benefactors
of The Fender Museum of The Arts Foundation.
* A co-payment is due
for each additional 8-week session after receiving the first 2 sessions free.
* Scholarships are available
upon request. Note: The Instructor must approve all requests for Scholarships.
Signature:
(Parent or Guardian if Minor) ________________________________
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For
Office Use Only
Date Received: ________________ By: ____________ Date
Entered Into System: _____________
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