Returning Student Registration
(Returning Students Only for the 2019-20 School Year. Please remember that the annual $40 recital fee must submitted in order to reserve your lesson slot for the upcoming year.
Student Name (First & Last) *
Your answer
Student Email
Your answer
Parent/Guardian Name (First & Last- If students is 17 years old or younger.) *
Your answer
Parent/Guardian Email (if applicable.)
Your answer
Mailing Address - street, bldg #
Please update if there has been a change to your address within the last year.
Your answer
Mailing Address - City, State, Country
Your answer
Mailing Address- Zip Code
Your answer
School Information
Please update school information section if student is entering a new school this year.
School Name
Your answer
Student Grade Level *
School Music Teacher Name
Your answer
Lesson Details
I'd like to learn the following additional instrument(s) during my instruction time. *
Required
What is your preferred location for lessons/tutoring? *
Students who are combining lesson locations may have to select one location if there is a conflict with another lesson request.
How long will each lesson be? *
Pick a preferred lesson day and start time (Eastern Standard Time). Lesson time subject to adjustments based on currently enrolled students' lesson times. *
Lesson time will be in effect on the following date: *
MM
/
DD
/
YYYY
Please describe any updates or changes that have occurred over the last year that may/will impact the student's performance during lessons.
Your answer
Media/Press Release Permission Statement
Must be confirmed with the parent/guardian of students 17 years old or younger.
I hereby assign and grant to ANG Music Services the right and permission to use and publish the photographs/film/videotapes/electronic/representations and/or sound recordings made of myself/the registered student during any and all of The Urban Flautistas (subsidiary of ANG Music Services) activities/events. I hereby release ANG Music Services from any and all liability from such use and publications. All media and images may be subject to use on various social media and digital marketing platforms including, but not limited to Facebook, Instagram, and YouTube. I hereby authorize the reproduction, copyright, exhibit, broadcast, electronic storage and/or distribution of said photographs/film/videotapes/electronic representations and/or sound recordings without limitation or notification at the discretion of ANG Music Services, and I specifically waive any right to any compensation I may have for any of the aforementioned. Please select one option. *
Returning registration form completed by: (enter name below) *
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.