Enrollment Form
New Student Enrollment Information
Enrollment Date *
MM
/
DD
/
YYYY
Student First Name *
Your answer
Student Last Name *
Your answer
Student Email *
Your answer
Student Birthdate *
MM
/
DD
/
YYYY
Home Street Number *
Your answer
Home Street Name *
Your answer
Home City *
Your answer
Home State *
Your answer
Student Cell *
(numbers only, no dashes or spaces please)
Your answer
Home Zip Code *
Your answer
Student School *
Your answer
Student Current Grade *
Your answer
First Name - Mom *
Your answer
Last Name - Mom *
Your answer
Email - Mom *
Your answer
Cell - Mom *
(numbers only, no dashes or spaces please)
Your answer
First Name - Dad
Your answer
Last Name - Dad
Your answer
Email - Dad
Your answer
Cell - Dad
(numbers only, no dashes or spaces please)
Your answer
Allergies *
Your answer
Emergency Contact
Your answer
Do parents play instruments? If so what instrument?
Your answer
What instrument/s does the student want to learn?
Your answer
What musical experience does the student currently have?
Your answer
Student Goals and Inspiration
What are their favorite bands?
Your answer
Other Student Interests
Your answer
Student's Learning Style
(check any that apply)
Learning Disabilities / Challenges
Your answer
How did you find out about us?
Your answer
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