Enrollment Form

Enrollment Form

Enrollment Fee: $80 one-time payment * Class Fee: $40 per hour
Name

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Name (if student is under 18)

First NameLast Name
Parent/Guardian Phone Number (if student is under 18)
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email Address
example@example.com
Instrument and Program Selection
Instrument(s) of Interest

Other
Lesson Duration
Experience and Goals
Previous Music Experience
Goals for Music Lessons
Any specific areas of focus or repertoire interests
Additional Comments or Special Requests
Preferred Lesson Day(s)
Emergency Contact Information
Emergency Contact Name

First NameLast Name
Relationship to Student
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Terms and Conditions:

I, [Student/Parent/Guardian Name], hereby enroll in music lessons at [Music School Name] and agree to abide by the terms and conditions outlined by the school. I understand that payment is due in advance for each lesson or session and that any cancellations or rescheduling must be made with [Music School Name] according to their policies.
Student/Parent/Guardian Signature
Date Signed

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Payment Options
Should be Empty:

Instrument and Program Selection