Jim Ronan - Ukulele Club Signup

Student Name

Age

School (Optional)

Grade (Optional)

Prior Music Experience

Has Your Child Played Ukulele Before?

Parent/Guardian Name:

Phone #

Phone

Email

Emergency Contact (Name)

Emergency Contact (Phone)

Medical/Allergy Info

Electronic Signature

Date

Attendance, Releases and Permissions

I understand this is a 4-week group program. Tuition reserves my child's place in class. Class dates are 4/20, 4/27, 5/4 & 5/11 2026. Class time is 6:00-6:45pm
I understand ukuleles will be provided for use during class and will remain at the studio.
I understand that respectful behavior is expected so all students can learn in a positive environment.
I authorize Jim Ronan to contact me regarding this program using the phone number or email above.

Photo/Video Permission

Yes - I give permission for class photos/video clips to be used for studio promotion.
No - Please do not use my child's photo/video for promotional purposes.

Tuition

Payment Method