Parent/Guardian's Name *

First Name

Last Name

Phone *

(###)

###

####

Student's Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Primary Instrument *

Guitar

Bass

Drums

Piano

Vocals

Ukulele

Other

Secondary Instrument

N/A

Guitar

Bass

Drums

Piano

Vocals

Ukulele

Other

How did you hear about Rock 101 NM? *

Current Student

Recommended by current Rock 101 Student or Parent

New Mexico Kid's Magazine

ABQ Mom Blog

KRQE

Google Search

Other

My student meets the Instrument & Skill Requirements. *

Link to document is located above form.

YES

I have read and agree with Rock 101's Terms & Conditions. *

Link to document is located above form.

YES