Student

First Name

Last Name

Date of Birth

Parent/Guardian

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email Address

Phone

Emergency Contact

Emergency Contact Phone

Medical Conditions we should be aware of

Class

Please select which class you would like to enroll in

Harp

Please indicate which type of harp you play and if you are interested in hiring an HHC harp

Pedal Harp

Lever Harp

Hire HHC harp for £10/class

Level

Briefly describe level and experience of playing

Thank you for registering for Hampstead Harp Class! You will receive a confirmation email soon with payment details and further information.