Early Childhood Workshop form | Academie Musique of Central Texas

Early Childhood Workshop formShelley Dennis2026-06-28T09:48:42-05:00

Early Childhood Music Theatre Workshop

"*" indicates required fields

Date*

Student Name*

First Last

Preferred Name and/or Pronouns

DOB*

Race*

This is used for grant funding purposes only.

Ethnicity*

Hispanic

Non-Hispanic

Decline to answer

This is used for grant funding purposes only.

Does the student have any medical conditions or allergies of which we need to be aware?

Parent/Guardian's Name*

First Last

Parent or Guardian's Name

First Last

Parent/Guardian's Primary Phone Number*

Primary Email*

Address*

Street Address Address Line 2 City State ZIP / Postal Code

Name of Emergency Contact (Separate from primary guardian)*

Emergency Contact Phone*

Emergency Contact Email*

I give permission to the Academie Musique to use pictures of my child for possible use on social media and website.*

Yes

Donation to our Scholarship and Moving Fund (Tax Deductable)

If you select "Other" donation, please enter the amount you would like to donate, and the amount will be added to the invoice and sent back to you.

Total

Please select the number of payments you will be making. Please pay all balances in full by July 31.*

1 Payment

2 Payments

Fun on the Farm

Price:

Donation $5

Price:

Donation $20

Price:

Donation $50

Price:

Donation $100

Price:

Anything else we should know?

Academie Musique of Central Texas
3001 Meadow Oaks Drive, Temple, TX 76502
Phone: (254) 228-0691
Email: director@amcentex.org

Monday – Thursday
2:30 – 6:30pm
Friday
3:00 – 6:30pm

Early Childhood Music Theatre Workshop

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OFFICE HOURS