New Student Registration

A. Student Information

First Name *

Middle Name *

Last Name *

Nick Name *

Place of Birth *

Date of Birth *

Age (auto)

Gender *

Address Name *

Address Street *

Phone Number *

Email *

Previous School *

Grade *

B. Father Information

Father First Name *

Father Middle Name

Father Last Name *

Father Occupation

Father Mobile Phone *

Father Email *

C. Mother Information

Mother First Name *

Mother Middle Name

Mother Last Name *

Mother Occupation

Mother Mobile Phone *

Mother Email *

D. Selected Program

Class Duration *

Class Type *

Preferred Day

Preferred Time

E. Additional Information

Previous Music Experience

Yes No

Please specify *

Special Needs / Notes

Yes No

Please specify *

F. Agreement

I hereby declare that the information provided is true and I agree to comply with the rules and policies of Euphony Atelier of Music and Development Center. By submitting this e-Form, it serves as valid proof or a substitute for a signature.

Date: