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  • 2026 to 2027 Ottley Music School Academic Year Child/Young Adult Registration Form

    Please read and fill out form carefully. If you have any questions, feel free to call us at (301) 454-0991 or to send us an e-mail at contact@ottleymusic.org.

  • Registrant Information

  • New or Returning Student*
  • I confirm that I am registering my child to attend Ottley Music School for the:*
  • Sex*
  • Date of Birth*
     - -
  • Student's Race or Ethnic Background. Please check all that apply. (OPTIONAL)
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Preferred Number of Contact

  • Parent/Guardian 1

  • Parent or Guardian 1 will be out first point of contact for students under 18 years of age.  For students under 18, and all students over 18, if the parents cannot be reached, list the name of at least one person who can be contacted in the event of an emergency.

  • Address Same as Child*
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Where would you prefer to be reached ?*

  • Parent/Guardian 2

  • Address Same as Child
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  •  -
  •  -
  • Where would parent/guardian 2 prefer to be reached?

  • Emergency Contacts

    For students under 18, parents cannot be listed as emergency contacts. For all students, list the name of at least one person who can be contacted in the event of an emergency. The emergency contact must live no more than 1 hour away and be over the age of 18.

  • Emergency Contact #1

  • Format: (000) 000-0000.

  • Emergency Contact #2

  • Format: (000) 000-0000.

  • Musical History

  • Student's Musical Ability in Primary Instrument*
  • Have you studied music previously ?*

  • Musical Goals

  • Do you own the instrument needed for lesson ?*
  • Do you need to rent an instrument ?*

  • Keyboards can be rented from the school. There are also instruments for sale. Send any inquiries to contact@ottleymusic.org.

  • How did you hear about us?

  • Scheduling and Lesson Cost

  • Lesson Length
  • Preferred Location*
  • Medical / Health Disclaimer

    Medical / Health Disclaimer

  • I declare and affirm that I have an active medical insurance*
  • 0/150
  • 0/150
  • Do you have a special health or medical condition that would influence your ability to perform in the class or may regularly intervene with your committed class time?*
  • 0/200

  • Statement of Understanding

  • Date Signed*
     - -

  • Payment

  • Payment is not required to submit this registration form. However, lessons will not be scheduled until receipt of payment. You will be invoiced when your submission is received.

    Thank you for considering the Ottley Music School. We look forward to seeing you in our halls.

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