Application for Free Instruments

248 599 – 2827

 
Application for FREE Instrument
 
Name of Child:   Age:  
Date of Birth:   Contact Number:  
       
Name of Parent or Guardian:  
Address:   City:  
State:   Zip Code:   Email:  
Home Phone:   Cell Phone:  
    Work Phone:  
Driver’s License Number (Show Interviewer): *Note: Address on License Must Match Address on Application  
 
Name of Child’s School:  
Name of Child’s Teacher:  
Address of School:  
   
Phone Number of School:   Email:  
Choice of Instrument:  
 
 
Additional Information
 
  The Parent or Guardian of all applicants MUST show proof of identification to receive an instrument.  Applicants MUST apply in person prior to the day that instruments will be dispersed.  Children receiving instruments are encouraged to take lessons at the Parham Academy of Performing Arts.  Group lessons are $15.00 per 30-Minute Lesson and $25.00 for private lessons   Children should be at least 10 years old to receive a woodwind or brass instrument.   Children should be at least 6 years old to receive a keyboard or drum pads.  
 
Does the child sing or play in the band or choir?  Yes             No
   
Why does the child wish to study music:
 
 
 
 
 
 
 
 
My signature below acknowledges that I understand and agree to the terms of this Agreement.
 
 
  
PRINTED NAME  
   
Signature of Parent/Guardian Date
   
   
Signature of Interviewer Date

1 Comment on “Application for FREE Instruments of EAS

  1. Pingback: CHRISTMAS TELETHON Educational Arts Society – Educational Arts Society

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