BUSINESS HOURS:  Monday thru Thursday  2pm – 8pm

Student Information

Date____________

Student Name_______________________________Age ___________

Parent or Guardian Name ____________________________________

Email ____________________________________________________

Address ___________________________City___________Zip______

Telephone # ______________________________________________

Emergency #______________________________________________

Instrument being studied____________________________________

Do you need a rental instrument? (Circle one)------------------ Yes No

Have you had lessons prior to enrolling at Mannington Music? Yes No

If yes, with whom? ________________________________________

What is your level of experience? ____________________________

(856) 935-4322