Please print this page out or email it to Miss W at shawnasmusicstudio@yahoo.com


1. Student's Name: ________________________

2. Parents' Names: __________________________________________________

3. Parents' Phone Number: __________________________________________

4. Cell Number: ____________________________________________________

5. E-mail Address: _________________________________________________

Do you wish to receive monthly newsletters and recital announcements via email? ____________

6. Age of Child: ______________________ (if applicable)

7. Which instrument? _______________________

8. Mailing Address: _________________________