Sound Mind Music Conservatory Registration Form

Conservatory Music Lessons Registration Form

Fill out the form carefully for a spot here at Sound Mind Music Conservatory
Sound Mind Music Conservatory is an organization dedicated to music advocacy, offering music technology and performing arts programs that spark creativity and inspire young artists to reach their full potential through creative learning. We are dedicated to providing high-quality music education, performance opportunities, and mentorship, to those we serve. We strive to cultivate a lifelong love of music and the arts while fostering personal and artistic growth. 🎶✨ - Dr. Cory D. Dugar
Student's Name

First NameMiddle InitialLast Name
Birth Date

MonthDayYear
Gender
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent's E-mail
example@example.com
Student's E-mail (optional)
example@example.com
Phone Number
Instrument or Course of Choice
30 min Lessons / $30

60 min Lessons / $50

60 min Group Lessons / $40
Type a question

Lafayette Location - 200 W. Willow St. - Philadelphia Christian ChurchPhoenix Location - 809 S. 7th Ave. - Saint Josephine Bakhita Mission Parish
Please provide any information that may be helpful to the student's musical success.
Requested Lesson Time(s) 30mins or 60mins (Please Specify in Comments)*
Additional Comments / Questions:
I certify that the information provided in this document is true, accurate, and complete to the best of my knowledge. I understand that this information will be used by Sound Mind Music Conservatory in its efforts to facilitate efficient music education, music therapy, and other related services.
Signature*

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Conservatory Music Lessons Registration Form