Teen Rock Band


General Information
Student's Name *
Student's Name
My child is willing to play another instrument: *
Date of Birth *
Date of Birth
Home Address *
Home Address
Primary Contact *
Primary Contact
Emergency Contact Information
Emergency Contact Name *
Emergency Contact Name
Emergency Contact Phone *
Emergency Contact Phone
Please include name, relation, and phone number.
Emergency Medical Information
Doctor's Number *
Doctor's Number
Health History
Behavior & Personal Needs
The George Center serves children with many different needs. To create the best environment for all our students, we need to know a little about your child’s behavior needs.
I understand that my child is expected to attend all rehearsals and performances. *
We understand that sickness, family emergencies, etc, may cause absence and for which there will be no penalty.
I have read and understand that the total amount due for Teen Rock Band is $350 per semester. *
I intend to use 3rd party funding.
Payment Plan A *
$70 monthly payment.
Payment Plan B *
Two installments of $350 due on August 31st and January 11th.
Today's Date *
Today's Date