Baldwin Music Education Center

If you are interested in enrolling your child at BMEC please fill out the following form and one of our representatives will contact you shortly. To have the most recent brochure mailed to you, please fill in your address. The Class times and days are listed under "classes". *required fields
*Your Name		*Email
A-Student's Name		Birth Date
B-Student's Name		Birth Date
Responsible Party
Address
City
State		Zip
Phone Number
Father's Name
Father's Work Phone
Mother's Name
Mother's Work Phone
Something special you would like us to know about your child(i.e. Nickname)

Please choose the class(es) you are interested in, along with day and time preference.
		Class Code	Day	Time
A-Student	1st
	2nd
B-Student	1st
	2nd
I was referred to the Baldwin Music Education Program by:

Additional comments or questions: