__________________________________ ______________________________
Child's Name Child's Age
__________________________________ ______________________________
Parent's Name Child's Date of Birth
__________________________________ ______________________________
Address Home Phone
__________________________________ ______________________________
City Cell Phone
__________________________________ ______________________________
State Zip Code Parent's E-mail
____ Beginning Guitar
____ Intermediate Guitar
____________________________________
Parent's Signature
Please include guitar class registration fee of $50.00 with this form. All checks should be
made payable to Firelight Enterprises.
Please mail completed registration form and payment to:
Firelight Performing Arts Academy
P.O. Box 174
Milton, LA 70558
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