Music Academy Form

Music Academy Private Lessons Enrollment
Today's Date*

MonthDayYear
Date
Returning Students: Current Instructor's Name, Cell Number and Email
Student's Name*

First NameLast Name
Are You a Beginning Student or Returning Student?*

BeginningReturning
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Student's Date of Birth*

MonthDayYear
Date
Parent(s) or Guardian(s) Name*

First NameLast Name
Father's Cell Phone
Mother's Cell Phone
Parent's Email*
example@example.com
Student/Parent Communication Preference:*

TextEmail
Instruction Requested*

BrassGuitarPianoPercussionVoiceWoodwinds
Day of the Week Preference (1st Choice)*

MondayTuesdayWednesdayThursdayFriday (Friday lessons must end by 12:00pm)
Day of the Week Preference (2nd Choice)*

MondayTuesdayWednesdayThursdayFriday (Friday lessons must end by 12:00pm)
Lesson Time*
Time of Day Preference?*

AM (8:00 - 11:45am)PM (Noon - 7:30pm)
Additional info you wish to supply/ request?
Please verify that you are human*
If Not, How Many Years of Experience?
Are You a Returning Student?*

YesNo
T-shirt Size*
Email*
example@example.com
Returning Students: Current Instructor Name, Cell Number and Email
Should be Empty:

Music Academy Private Lessons Enrollment