PJ Music Studios New Student Registration Form
Please fill out this form, we will be in touch.
Student Information
Student First Name
Your answer
Student Last Name
Your answer
Year of Birth
Your answer
Date of Birth (optional)
MM
/
DD
/
YYYY
Phone Number
Your answer
Email
Your answer
Address
Your answer
Parent (or Guardian) #1 - Name
Your answer
Parent (or Guardian) #1 - Phone or Email
Your answer
Parent (or Guardian) #2 - Name
Your answer
Parent (or Guardian) #2 - Phone or Email
Your answer
Payment Information
Method of Payment
Required
Person(s) Responsible for Payment
Your answer
Music Lesson Information
Categories
If you select Strings, brass, or woodwind, please enter specific instrument:
Your answer
If you select Guitar, please choose one of the following genres:
Name of Preferred Teacher
Your answer
Level of Study (for example, RCM grade)
* If you chose "Other", please enter details (for example, theory, Composition, ...):
Day of Your Classes
Time of Your Classes
Time
:
Referred by
Your answer
Are you taking more than one subject (piano, guitar, violin, theory, etc...)
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