Register with BackBeat City

Basic Info

First Name:*

Last Name:*

Age:*

Gender:*
 Female  Male

Address:*

City:*

State:*
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Zip:*

Phone:*

Date of Birth:*
MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Day01020304050607080910111213141516171819202122232425262728293031 Year197519761977197819791980198119821982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006

School:*

Parent Contact Information

Mother's Name:

Mother's Cell Phone:

Father's Name:

Father's Cell Phone:

Preferred Email:*

Alternate Email:

Do you have other children enrolled at BackBeat City? If so, please list below:

How did you hear about us?
 Flyer / Newspaper Internet Friend / Relative Other

Please describe any special needs / allergies of the child(ren) being enrolled today.

Emergency Contact (Other than parent / guardian)

Emergency Contact Name:*

Emergency Contact Phone:*

Relationship to Student:*

Class / Activity Selection

• Click here to view the 2011-2012 Fee Schedule and Class Calendar.

Activity:*
Choose Below...InstrumentClass

Desired Lesson Length:*
Choose Below...30 Minutes45 Minutes60 Minutes

Music Groups:
 BackBeat BeatBox BackBeat Singers Rock Band BackLash BEBOP

Dance Level:
Choose Below...YouthIntermediate

Dance Type:
 Jazz Ballet Tap Hip-Hop

Drama:
 Acting 1 Acting 2 Improv Musical Theater

Are you interested in joining us for our FREE monthly seminar, "Parenting Today's Child," with Greg Colossale?:
 Yes No

Please check the boxes below to continue:*
I agree to the terms and conditions.

I agree to the class and lessons policy.

Complete Registration