Dave Simon’s Rock School Sign Up Form
Students Last Name:
Students First Name:
Students date of birth:
Instrument(s) your child plays:
Years or months playing instrument(s):
Mailing address(including zip code):
Would you like to receive your billing invoice via email?
How did you hear about Rock School?
Is your child currently taking private lessons?
Please check all available time slots
3:00 3:30 4:00 4:30 5:00 5:30 6:00 6:30 7:00 7:30
10:00 10:30 11:00 11:30 12:00 12:30 1:00 1:30 2:00 2:30 3:30 4:00 4:30
By signing this document I, (name)______________________________grant Dave Simon’s Rock School permission to use either a
photograph, video or film image of my child for the promotion of Rock School. Promotional materials include Dave Simon’s Rock
School web site, brochure, poster orNews related mediums.
1305 Baur Blvd St. Louis MO 63132 314.692.7625