Enrollment Form

Student Name *

First Name

Last Name

Parent/Guardian Name *

First Name

Last Name

Phone *

(###)

###

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Lesson location *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Instruments *

Piano

Guitar

Drums

Violin

Voice

Bass

Ukulele

Technology for Music

Has the student had any previous music instruction? *

Yes

No

Please check to AGREE with the following policy *

I agree that if the student is under 18 years old, there must be an adult other than the instructor on the premises at all times during the lessons.

Date *

MM

DD

YYYY