New Student Information Form
Please fill out this short survey so that we can learn a little bit about you as a prospective student!! All this information is held privately by Brendan Mondell, our Admissions and Enrollment Director.
First and Last Name of New Student: *
Your answer
First and Last Name of Secondary Contact:
Fill this out if you're the parent of the new student.
Your answer
Gender: *
Student's Date of Birth (MM/DD/YR): *
Your answer
Student's Age *
Your answer
Student's Address: *
Please list your street/mail box number, street name, city/town of residence, state and zip code. Please use the student's primary address.
Your answer
Home Phone #: *
Please include area code. Ex:000-000-0000
Your answer
Student's Cell Phone #:
Please include area code. Ex:000-000-0000
Your answer
Parent's Name
Your answer
Parent's Cell Phone #:
Please include area code. Ex:000-000-0000
Your answer
Student's E-Mail Address: *
Your answer
Parent's E-Mail Address:
Your answer
What is the student's county of residence? *
Your answer
If applicable, what school does the student attend?
Your answer
What instrument do you wish to receive lessons with? *
Select all that apply.
Required
Do you have previous experience with that/those instrument(s)? If so, how much? *
Your answer
What styles of music do you listen to, or would like to learn? *
Your answer
What type of enrollment are you interested in? *
Select all that apply.
Required
What are the preferred days (M-F) and times for your private lessons/workshops/classes? *
Your answer
Questions or Comments?
List any questions you might have about our program to give Brendan time to find the answer!
Your answer
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