Parent/Guardian *

First Name

Last Name

Phone *

(###)

###

####

Is a parent(s) interested in co-learning?

Parents can co-learn with their child in Guitar 1 for free!

Yes

No

Would you like automated billing? *

Billed on the 1st of each month.

Yes - (Riverton Music students only)

No - (Riverton Music students only)

N/A

How did you hear about us?

Website

Friend Referral

Riverton Music

Gene Fullmer Recreation Center

JL Sorenson Recreation Center

Student Name *

First Name

Last Name

Student Name

First Name

Last Name

Student Name

First Name

Last Name

Student Name

First Name

Last Name

Which class would you like to sign up for? *

Please choose more than one if your schedule allows

Wednesday Guitar 3 4:00pm-4:45pm

Wednesday Guitar 2 4:45pm-5:30pm

Wednesday Guitar 3 5:30pm-6:15pm

Wednesday Guitar 2 6:15pm-7:00pm

Wednesday Guitar 2 7:00pm-7:45pm