Today's Date
/
Month
/
Day
Year
Date
Student Name
First
Middle
Last
Nickname
Birthdate
/
Month
/
Day
Year
Date
Name of school:
Grade in school:
Instrument
If piano, type
(grand, upright, digital)
Health concerns/allergies
Parent 1 Name
First
Last
Parent 1 Phone Number
Please enter a valid phone number.
Parent 1 Email
example@example.com
Parent 1 Address
Street
City
Zip
Parent 2 Name
First
Last
Parent 2 Phone Number
Please enter a valid phone number.
Parent 2 Email
example@example.com
Parent 2 address (if different)
Street
City
Zip
Student: Why are you taking music lessons?
Student: What kind of music do you like?
Student: Have you taken music lessons before? How long?
Student: What are your after school activities or activities you enjoy?
Parents: What is your musical background?
Parents: How much time are you able to put into your child's musical development?
(help with practicing, attending concerts, etc.)
Do you give permission for your child's photo to be posted on the BAM website or private Facebook group?
(yes or no)
How did you hear about us?
Who referred you?
Submit
Should be Empty: