Student Information Form Student Information Please fill out the form below to register your student(s) for classes. We will follow up with you with specific options for class times. Please choose one of the two options:(Required) I am a parent or guardian registering students I am an adult registering myself Parents and guardians, how many students are you registering?One StudentTwo StudentsThree StudentsFour StudentsPrimary Contact (Adult Student) First Last Adult Student Date of Birth MM slash DD slash YYYY Adult Student Current AgeAdult Student Cell PhoneOK to text you? Yes No Adult Student Email (note this will be used for Google Classroom and Evernote)Classes Adult Student is Interested in: Piano Voice Guitar Ukulele Drums Adult students, list experience related to the musical instrument(s) you are interested in:Session of Interest for Adult Student School Year - October 2021 - June 2022 Summer Session - 2022 Camp Workshop Ongoing / Year-round Tell us when you are NOT available for lessonsAdult student, are there special circumstance or medical condition that we should be aware of?Student 1 Name First Middle Last Student 1 Date of Birth MM slash DD slash YYYY Student 1 Current AgeStudent 1 Cell PhoneStudent 1 OK to Text? Yes No Student 1 Email for Google Classroom and Evernote What Grade is Student 1 in?K or earlierGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6Grade 7Grade 8Grade 9Grade 10Grade 11Grade 12College or AboveStudent 1 Favorite Subject in School Classes Student 1 is Interested in: Piano Voice Guitar Ukulele Drums List experience for Student 1 related to the musical instrument(s) he or she is interested in:Session of Interest for Student 1 School Year - October 2021 - June 2022 Summer Session - 2022 Camp Workshop Ongoing / Year-round Tell us when Student 1 is NOT available for lessonsAre there special circumstance or medical condition about Student 1 that we should be aware of?Student 2 Name First Middle Last Student 2 Date of Birth MM slash DD slash YYYY Student 2 Current AgePlease enter a number from 0 to 99.Student 2 Cell PhoneStudent 2 OK to Text? Yes No Student 2 Email for Google Classroom and Evernote What Grade is Student 2 in?K or earlierGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6Grade 7Grade 8Grade 9Grade 10Grade 11Grade 12College or AboveStudent 2 Favorite Subject in School Classes Student 2 is Interested in: Piano Voice Guitar Ukulele Drums List experience for Student 2 related to the musical instrument(s) he or she is interested in:Session of Interest for Student 2 School Year - October 2021 - June 2022 Summer Session - 2022 Camp Workshop Ongoing / Year-round Tell us when Student 2 is NOT available for lessonsAre there special circumstance or medical condition about Student 2 that we should be aware of?Student 3 Name First Middle Last Student 3 Date of Birth MM slash DD slash YYYY Student 3 Current AgePlease enter a number from 0 to 99.Student 3 Cell PhoneStudent 3 OK to Text? Yes No Student 3 Email for Google Classroom and Evernote What Grade is Student 3 in?K or earlierGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6Grade 7Grade 8Grade 9Grade 10Grade 11Grade 12College or AboveStudent 3 Favorite Subject in School Classes Student 3 is Interested in: Piano Voice Guitar Ukulele Drums List experience for Student 3 related to the musical instrument(s) he or she is interested in:Session of interest for Student 3 School Year - October 2021 - June 2022 Summer Session 2022 Camp Workshop Ongoing / Year-round Tell us when Student 3 is NOT available for lessonsAre there special circumstance or medical condition about Student 3 that we should be aware of?Student 4 Name First Middle Last Student 4 Date of Birth MM slash DD slash YYYY Student 4 Current AgePlease enter a number from 0 to 99.Student 4 Cell PhoneStudent 4 OK to Text? Yes No Student 4 Email for Google Classroom and Evernote What Grade is Student 4 in?K or earlierGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6Grade 7Grade 8Grade 9Grade 10Grade 11Grade 12College or AboveStudent 4 Favorite Subject in School Classes Student 4 is Interested in: Piano Voice Guitar Ukulele Drums List experience for Student 4 related to the musical instrument(s) he or she is interested in:Session of interest for Student 4 School Year - October 2021 - June 2022 Summer Session 2022 Camp Workshop Ongoing / Year-round Tell us when Student 4 is NOT available for lessonsAre there special circumstance or medical condition about Student 4 that we should be aware of?Primary Contact SectionPrimary Contact (Parent/Guardian) First Last Address Street Address City State / Province / Region ZIP / Postal Code Primary Contact Cell PhonePrimary contact, OK to Text? Yes No Primary Contact's Work PhonePrimary Contact Occupation Name of Emergency Contact Emergency Contact Phone NumberPrimary Contact Email What is your relationship with the student(s) you are registering? Mother Father Guardian Other If applicable, who is the student's other parent? First Last What is the relationship of the other parent with the student(s) you are registering? Mother Father What is the second parent's occupation? Second Parent's Cell PhoneSecond Parent's Work PhoneSecond Parent's Email How did you hear about us?Payment SectionPlease select your payment type.Please choose one of the payment options below:(Required) Group classes: $95/month per student (see Auto-Pay form) Private (if available): $165/month per student (see Auto-Pay form) Workshop: (Cost will be listed as workshop offerings are posted) Agreement SectionAgreement(Required) I have read and agree to all studio policy terms and conditions as stated on the websiteSignature(Required)
