I am registering for: *

Name *

Age *

Occupation *

Home Address *

Mobile Phone Number

Home Phone Number

Which form of communication do you most prefer? *

In case of an emergency, who should I contact? Please list name and phone number *

What type of instrument will you be using for home practice? *

Describe your previous music background. *

Are you currently studying another music instrument? If so, please describe. *

What are your goals for taking lessons? *

What styles of music do you listen to most? *

Is there any type of music you would prefer not to study? *

I plan to pay for tuition in the following way: *

By typing my name and date below, I am electronically signing this document to indicate that I have read the full mfMusicStudio Policy at www.mfmusicstudio.com/about-the-studio and agree to abide by the terms listed in the policy. *

(This is optional) By typing my name and date below, I am electronically signing this document to grant Margaret Fontiveros the right to take photographs or videos of my family in connection with any mfMusic Studio event. I authorize Margaret Fontiveros to use and publish the same in print and/or electronically. I agree that Margaret Fontiveros may use such photographs/videos of us with or without our names and for any lawful purpose, including for example such purposes as web content or Facebook newsfeed. .