Enrollment Form

Student's Name(required)

Student's Birthday m/d/y(required)

Student's School(required)

Parent's Name(s)(required)

Cell Phone(required)

Home Phone(required)

Home Zip Code(required)

Parent's Email(s)(required)

Does student have any physical/learning disabilites?(required)

Yes No Would prefer to discuss in person

If Yes, please provide details.

How did you hear about Mike Slayen Studios?(required)

I understand upon withdrawal of lessons I must inform instructor by email by the 15th of the month prior to withdrawal or following month's tuition is due in full.(required)

Agree

Comments

Mike offers $20 of one month's tuition for your referrals. Do you have any friends that might like to enroll as well?(required)

Yes No

If yes, you can provide preferred contact info of possible referrals or pass Mike's info to them

Mike check:

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