Jenny Case on the Bass!

Hello current and prospective students/parents!

Please fill out the following information so I can have it on file, and if anything changes in the future, let me know so I can keep my records updated.
Also, please make sure to read over my current LESSON POLICY before completing the section below.
Thanks and rock on!!!

Student First & Last Name:*

Student Birthdate (optional):

Parent/Guardian First & Last Name:

Street:*

City:*

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Home Phone:

Parent/Guardian Cell Phone:

Student Cell Phone:

Parent/Guardian Email Address:*

Student Email Address:

Emergency Contact:*

Emergency Contact Phone:*

Instrument:*
Bass
Guitar
Piano/Keyboard
Songwriting/Recording
Vocals

Other comments?:

I have read and agree to the *JCMS Lesson Policy* terms.:*
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