Fender Center Application

Fender Center Application
Applicant's Name*

First NameLast Name
Age*
Applicant Birth Date*

MonthDayYear
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Name

First NameLast Name
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email (Most communication is via email, if you cannot utilize email let us know!)*
Home Number*

Area CodePhone Number
Cell Number

Area CodePhone Number
Work Number

Area CodePhone Number
Employment Information: Mother/Guardian

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Employment Information: Father/Guardian

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Applicant's School Name
Applicant's School Type
Ethnicity (Optional: This information is collected in aggregate for Grant Applications & Reporting.)
Performing Arts Course*
Lesson Level*
Release: My child may be recorded or photographed during lessons, showcases, or concerts for marketing purposes. *
How did you hear about us?*
- All applicants are registered on a first come first served basis

- Refund Policy: ALL PAYMENTS ARE FINAL. NO REFUNDS, NO EXCEPTIONS regardless of unforeseen circumstances or changes to class schedule.

- Every precaution will be taken to provide the class as specified.
Date

MonthDayYearHourMinutesAM/PM Option
Please let us know if you have a coupon!
Signature*

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