BCNY Media Academy Registration Form

BCNY's Audio Engineering & Production Program Student Registration Form

Every Saturday from 12 PM-4 PM, starting October 21, 2023 and ending December 9, 2023. Boys/young men, from ages 12-21, are eligible. Registration will close on October 13, 2023. This program will be free for all participants. Metrocards & lunch will be provided. Please email D.Julien at djulienmusic@gmail.com for more information or questions. Fill out this form for registration.
Student's Name*

First NameMiddle NameLast Name
Student's Birth Date*

MonthDayYear
Student's Mobile Number*

Area CodePhone Number
Student's Address*

Street Address

CityState / Province

Postal / Zip Code
Student's School
Student's E-mail Address*
example@example.com
Student's T-Shirt Size*
Are you currently a member of The Boy's Club of New York?*
Does member have permission to go home on their own?

YesNo
Why are you interested in joining BCNY's Audio Engineering & Production Program?*
Do you own a laptop?*
How much experience do you have with audio engineering?*
How much experience do you have with audio production?*
What is your favorite genre of music?*
Would you consider yourself more of an auditory learner or a visual learner?*
Parent/ Legal Guardian's Name*

First NameLast Name
Parent/ Legal Guardian's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/ Legal Guardian's Mobile Number*

Area CodePhone Number
Parent/ Legal Guardian's Work Number

Area CodePhone Number
Is your parent/legal guardian your emergency contact?*
If no, please provide your emergency contact's full name, mobile number, work number if applicable, and define their relationship to you.
Should be Empty:

BCNY's Audio Engineering & Production Program Student Registration Form