Enrollment Form

Enrollment Form

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

First NameLast Name
Date of Birth*

MonthDayYear
Date
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.
Parent/Guardian Email Address
example@example.com
Instrument and Program Selection
Instrument(s) of Interest*

PianoGuitarTrumpet or SaxDrumsSound techniqueBass GuitarPercussionOther
Lesson Duration*

2 hrs..
Experience and Goals
Previous Music Experience*

BeginnerIntermediateAdvanced
Goals for Music Lessons
Any specific areas of focus or repertoire interests
Additional Comments or Special Requests
Preferred Lesson Day(s)*

MondayTuesdayWednesdayThursdayFridaySaturday
Emergency Contact Information
Emergency Contact Name

First NameLast Name
Relationship to Student
Emergency Contact Phone Number
Please enter a valid phone number.
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

Powered by Jotform SignClear
Date Signed

MonthDayYear
Date
Payment Options*

CashApp ($PMA725)Zelle (786-916-4219)
Should be Empty:

Enrollment Form

Instrument and Program Selection

Experience and Goals

Emergency Contact Information