Semester 1 Private Vocal & Instrumental Lesson Registration Form
Student's Last Name *
Your answer
Student's First Name *
Your answer
Grade *
Your answer
Parent/Guardian Name *
Your answer
Address *
Your answer
Home Phone Number *
Your answer
Cell Phone Number *
Your answer
Contact & Notification Email *
Please provide an email address that is checked regularly by a parent/guardian.
Your answer
Student Email
Please provide an email address for your student if you would like us to communicate directly with them regarding changes in lesson schedules.
Your answer
Medical/Allergy Information *
Please list any allergies, medical conditions and/or other accommodations necessary to ensure your student's safety and full participation while in our care. If there are no special concerns, please type "NONE".
Your answer
Does your student require an Epi-Pen? *
Emergency Contact Name *
Please provide the name of an emergency contact if we are unable to reach a parent/guardian.
Your answer
Emergency Contact Phone Number *
Your answer
Parent/Guardian Permission *
Please initial below to give permission for your student to participate in the Office of Family & Community Engagement's Enrichment Programs.
Your answer
Media Release *
Do you give the Office of Family & Community Engagement permission to photograph your student and to publish photos and/or original student work in any print or digital format including social media platforms?
Preferred Length of Lesson *
Trumpet/Brass Instrumental Lessons - Mondays
Please indicate your choice of instruments below.
Your answer
Oboe/Bassoon/Clarinet/Saxophone Instrumental Lessons - Mondays
Please indicate your choice of instruments below.
Your answer
Saxophone/Clarinet Instrumental Lessons - Tuesdays
Please indicate your choice of instruments below. Lessons will begin at 5:30pm
Your answer
Clarinet/Piano Instrumental Lessons - Tuesdays
Please indicate your choice of instruments below.
Your answer
Percussion Instrumental Lessons - Tuesdays
Please indicate your choice of instruments below.
Your answer
Trombone/Euphonium/Tuba Instrumental Lessons - Tuesdays
Please indicate your choice of instruments below.
Your answer
Guitar/Piano Instrumental Lessons - Wednesdays
Please indicate your choice of instruments below.
Your answer
Trombone/Euphonium/Tuba Instrumental Lessons - Thursdays
Please indicate your choice of instruments below.
Your answer
Guitar/Piano Instrumental Lessons - Thursdays
Please indicate your choice of instruments below.
Your answer
Flute Lessons
Vocal Lessons
No Vocal Lessons on 9/21. First lesson will be held on 9/28.
Preferred Lesson Time
First Choice
Preferred Lesson Time
Second Choice
Preferred Lesson Time
Third Choice
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