2860 Aborn Road, San Jose, CA 95135

(408) 223-1888

Evergreen Studio of Music & The Arts(ESOMA)

2860 Aborn Road, San Jose, CA 95135
(408) 223-1888, www.evergreensoma.com

REGISTRATION FORM

Programs:(check all that apply)

  • Piano
  • Guitar
  • Violin
  • Voice
  • Theatre/Acting
  • Others

Student Information:

Parent / Guardian Information:

Emergency ContactInformation:

In case of emergency and neither parent of guardian can be reached, please list any or all relative/sor friend/swe may contact:(use back of the form for additional information)

Insurance / MedicalInformation:

Complete &mail this form to Evergreen Studio of Music & The Arts (ESOMA). If new student, please send a check to cover the non-refundable $20 registration fee.

Parent/Guardian Signature, Date

Student Signature (over 18), Date