Enrollment Form 2022-2023
Sign in to Google to save your progress. Learn more
Email *
Student Name *
Date of Birth *
School *
Address *
City *
State *
Zip *
Home Phone *
Mother's Name *
Mother's Cell *
Mother's Email *
Father's Name *
Father's Cell *
Father's Email *
Emergency Contact Name *
Emergency Contact Phone *
Instrument Desired *
Teacher Preference *
Please tell us about your child's music background: *
What goals do you have for your child in studying an instrument this year? *
Lessons are typically 30 minutes long, once per week and are held at Mountain View Music, 217 E. Main Street, Front Royal, Virginia.
What are your preferred dates and times?  Please provide three choices. *
Are you interested in other music course offerings, such as a music theory class, group piano, or sharing your music with others?  Examples might be a Saturday morning playing at a nursing home or doing a demonstration class at the library. *
Minor Child Photo/Video Release
I, the parent or legal guardian (name entered below) of the student listed at top of this form, grant Mountain View Music my permission to photograph or take videos of my child for student recognition, publicity, advertising, and web content. I understand that my child’s name will NEVER appear alongside or with photos or videos that are released outside of the studio.  Furthermore, I understand that no royalty, fee or other compensation shall be come payable to me by reason of such use. I also understand that I may revoke this permission at any time.
Parent or legal guardian *
I agree to the terms of the minor child photo/video release statement. *
Assumption of Risk and Waiver of Liability Related to Injury and Illness

On behalf of myself, my child, and any successor guardian of my child, I hereby release, covenant not to sue, and agree to hold harmless Tapsak Enterprises, LLC, Mountain View Music, their employees, staff, volunteers, representatives, and members on any and all claims, liabilities, harm, damages, costs, or expenses related to any injury or illness, including the contraction of COVID-19.

Mountain View Music will invoice electronically for the new student registration fee ($25). Lesson tuition will be paid directly to teacher.

Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy