MELODY PIANO STUDIO

ENROLLMENT FORM

Student Name­­­­­­­­­­________________________________________________________

Address______________________________________________________________

City_____________________State_____________________Zip_________________

Telephone____________________________________________________________

Mother’s Name_______________________________________________________________

Address______________________________________________________________

Telephone(H)_________________(W)___________________(C)_________________

Father’s Name_______________________________________________________________

Address______________________________________________________________

Telephone(H)_________________(W)___________________(C)_________________

Emergency ___________________________________________________________

Telephone____________________________________________________________

To assure a place for your child for the 2009-2010 school year, return this form to:

Yun Jiang, Melody Piano Studio, 19 Arnold Rd., Pelham, MA 01002

Phone: 508.264.2730             E-mail: info@www.melodypiano.com