Raise the Bar | Virtual Music Mentorship Program

Raise the Bar | Virtual Music Mentorship Program | 2023

STUDENT REGISTRATION FORM
Come join us for a free, fun musical experience with your own private teacher! Take your musical skills to the next level through individualized mentorship and weekly lessons for dedicated students like you.

FEB. 26 - APR. 22 2023

STUDENT REGISTRATION
Name

First Name Last Name
Parent/Guardian's Name

First Name Last Name
Best Contact Student Email (must have access outside of school)
example@example.com
Parent's Email
example@example.com
Student Phone
Please enter a valid phone number.
Parent/Guardian Phone
Please enter a valid phone number.
Address (for mailing end of program information)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Age
Instrument (your main instrument you have studied at least 1 year)
School

Guidelines & Permissions

Please read the following carefully.
STUDENT AGREEMENT FORM
This signifies your agreement for your student to follow the above guidelines and expectations, grants permission for their name and contact information to be sent to a music mentor, and grants permission for their photo to be used in social media for advertising & review purposes. *More than 2 unexcused absences from lessons will signify your release from any of these terms and your mentorship spot to be granted to another student on the waiting list.
Signature of Parent/Guardian:

Clear
Date:

MonthDay Year
Date
For more information, see www.bravowaukegan.org and look for "Raise the Bar" under the "Programs" tab.

Contact Program Director, Heather Beckman, at raisethebar.bravo@gmail.com with any questions or concerns.

Student Matches will be made in late January and you will be notified via email.
Should be Empty:

Raise the Bar | Virtual Music Mentorship Program | 2023