NEMPAC - The North End Music and Performing Arts Center

COMPLETE THIS FORM TO REGISTER FOR COURSES

Name (Last):	Name (First):

Street Address:

Email Address:	Parent(s)/Guardian (if applicable):

The person my child will come to class/lessons with:

Emergency Contact Name:	Emergency Contact Phone:

Student Age:	Grade (if applicable):	School (if applicable):

Course:

Anything else you would like us to know: