School Location        : ___________________________________

Start Date                : ___________________________________

Student Name          : ___________________________________

Student Age             : ____________________________________

Parent Name           : ____________________________________

Home Address         : ____________________________________

                                   ____________________________________

Home Phone            : (____) ______________________________

Work Phone            : (____) ______________________________

Courses (please specify)

_______________________________            

______________________________   $

Registration Fee                                                         $ 25

Total                                                              $

Please send the enrollment form and payment to:

Concert Music School

4952 Warner Ave. Suite 111

Huntington Beach, CA 92649

You may also fax the enrollment form to us at (714) 377-4941

Or email us at:

enroll@concertmusicschool.com