Student Application

Contact Info
Full Name*

First NameLast Name
Parent / Guardian (if student is a minor)

First NameLast Name
Phone Number*
Alternate Phone

Area CodePhone Number
E-mail*
Alternate E-mail
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Birth month
Birth day
Age*

9-1213-1718+
Emergency Contact*

First NameLast Name
Referred by

Policies Agreement

The policy can be found at www.musicforpurpose.com.

Should be Empty: