Student Registration

Student Registration

Bellevue Academy of Arts & Music
Student Information

For students under the age of 18
Approval Code*
Enter the code to activate the form.
Student is*

MaleFemale
Application Date*
Student Full Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade*
School Currently attending*
Student Email
The parent gives consent to communicate with a minor student by filling this box.
Previous experience(s) in the field(s) which I am applying for is, * years months.
Teacher Request*

YesNo
Name of the teacher
Parent / Guardian Information

Students who are 18 years old and up, please fill in your additional information.
Name*

First NameLast Name
Relationship*
Contact 1*
Please enter a valid phone number.
Contact 2 (Emergency)
Please enter a valid phone number.
Parent Email*
Please provide your main email for communication purposes.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Program Registration
I am registering for (select all that apply):*

Private Piano LessonPrivate Violin LessonTheory/History ClassEnsembles & ChoirCampsAfterschool ProgramFine ArtsAdult Class
I am aiming for:*

Division 1, to become an Amateur MusicianDivision 2, to become an Associate MusicianDivision 3, to become an Elite Professional MusicianUndecided, I am joining for special programs only
Registration Fee

Privacy and Consent

Your choice does not affect registration status. This field will override the Waiver (next page) for Registered-Students in the Private Division during the school year only (Sept-June).
I give permission for my child's full name to be used on the studio website and related materials (the first name is used without consent).*

YESNO
I give permission for my child's picture to be used on the studio website and related materials.*

YESNO
Terms and Conditions*
Signature*

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Student Information