Student Registration

Contact Name*

First Last

(Parent/Guardian/Adult Student)

Contact Phone*

Contact Email*

Enter Email Confirm Email

Contact Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Student Name*

First Last

(Under age of 18 or Self for adult students)

Student's Age*

Assigned Teacher*

Student Birthday*

**I agree to be registered for Shining Light Music’s email database to receive updates on the lessons program and the latest news at Shining Light Music*

I Agree

Read the policies here

**I have read Shining Light Music’s policies for private lesson students and agree to abide by those policies. Included is my annual $20 registration fee, due upon enrollment in Shining Light Music’s lessons program.*

I Agree

Name

This field is for validation purposes and should be left unchanged.

816.347.0099

Please submit this form for each paid student registration.

Student Registration Form