Student Registration Form

Registration Form

Submitting this form does not obligate you to begin lessons. It is merely a tool to help us gauge your interests and offer scheduling options. There is NO Registration Fee.
Please do not use this form for Encore Theatre Classes/Auditions, Summer Camps, Art Classes or Daydream Art Parties.
Private Lessons: (check all that apply)

PianoVoiceAcoustic GuitarElectric GuitarResonator Guitar (Dobro)Bass GuitarBanjoMandolinUkuleleDrumsViolinViolaCelloDouble Bass (Upright Bass)TrumpetTromboneFrench HornEuphoniumSaxophoneClarinetFluteOther
I am available for lessons on: (check all that apply)

MondayTuesdayWednesdayThursday
Lessons only: I can come to lessons during the following times: (check all that apply)

Early afternoon (1-3 pm)Late afternoon (4-6 pm)Early Evening (6-8 pm)
I would like my lessons :

in person at Fine Arts Center of Easleyonline via Skype, Facetime, etcI'm flexible and can do eitherI'm not sure, tell me more about these options
I would like to begin lessons:

As soon as possibleAt the beginning of the next monthOther
Student Name*

First NameMiddle NameLast Name
Birth Date *

MonthDayYear
Has this person taken lessons on this instrument before?

NoYes, less than 1 yearYes, 1-2 yearsYes, 2-3 yearsYes, 3+ years
Parent Name (if student is a minor)

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email of Person responsible for payment *
example@example.com
Mobile Number*

Area CodePhone Number
Home Phone Number

Area CodePhone Number
Additional Comments (anything you want us to know about the student or any questions you would like to ask)
Emergency Contact Name (Other than Parent listed above)

First NameLast Name
Emergency Contact Phone Number

Area CodePhone Number
How did you hear about the Fine Arts Center of Easley?*

FacebookI have taken lessons there beforeFlyer or AdGoogleI heard about FACE from a current or former student/parent.Other
Should be Empty: