MAC Student Enrollment Interest Form
Midlands Arts Conservatory is open to all students who are residents of South Carolina.
Enrollment Year *
STUDENT INFORMATION
Last Name *
Your answer
First Name *
Your answer
Middle Name *
Your answer
Gender *
Age *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Current School *
Your answer
Grade *
Your answer
Interested in which art discipline: *
Required
Home Address *
Address, City, State and Zip Code
Your answer
GUARDIAN INFORMATION
Guardian 1 First & Last Name *
Your answer
Guardian 1 Relationship to Student (Mother, grandmother, aunt, etc.) *
Your answer
Guardian 1 Primary Contact # *
Your answer
Guardian 1 Secondary Contact #
If applicable.
Your answer
Guardian 1 Email Address *
Your answer
Guardian 2 First and Last Name
Your answer
Guardian 2 Relationship to Student (Father, grandfather, uncle, etc.)
Your answer
Guardian 2 Primary Contact #
Your answer
Guardian 2 Secondary Contact #
Your answer
Guardian 2 Email Address
Your answer
OTHER INFORMATION
Does this student have a SIBLING who currently attends MAC *
How did you learn about MAC? CHECK ALL that apply. *
Required
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