Parent/Guardian's Name *

First Name

Last Name

Phone *

(###)

###

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Student's Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Select Session: *

Young Guns: Ages 7 - 11 • Old School: Ages 12 - 18

Young Guns Session 1: June 5- June 9

Old School Session 1: June 5- June 9

Young Guns Session 2: June 19 - June 23

Old School Session 2: June 19 - June 23

Young Guns Session 3: June 26- June 30

Old School Session 3: June 26- June 30

Young Guns Session 4: July 17 - July 21

Old School Session 4: July 17 - July 21

Young Guns Session 5: July 31 - Aug 4

Old School Session 5: July 31 - Aug 4

Primary Instrument *

Guitar

Bass

Drums

Piano

Vocals

Ukulele

Other

Secondary Instrument

N/A

Guitar

Bass

Drums

Piano

Vocals

Ukulele

Other

Interested in Early Drop Off / Late Pick Up?

Young Guns: Early Drop Off starts at 8:30 am, and Late Pick Up ends at 12:30 pm. Old School: Early Drop Off starts at 12:30pm, and Late Pick Up ends at 4:30 pm. We will send a separate email with details if interested.

Yes

No

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

I have read and agree with Rock 101's Summer Session Policy & Agreement. *

Link to document is located above form.

YES