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Registration
Rock Town Music Academy
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Student Name
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Student Age
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Birthday
MM
/
DD
/
YYYY
Address
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Phone
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Email
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Instrument(s) of study at RTMA
Voice
Piano
Guitar
Bass
Drums
Dominant hand
Right
Left
Both
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Favorite musical artists/bands
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Name 3 songs you'd like to learn
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Musical Experience
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Disabilities/ Allergies/ Health Concerns
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Lesson day, time and start date
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Parent name(s)
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Parent phone
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Parent email
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Emergency Contact- name and phone
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Please name all who may pick child up from their lessons.
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Photos/ videos may be taken at classes and performances for promotional/ community purposes. Do we have permission to highlight/post student on school’s social media/ web page/ brochures?
Yes
No
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If yes on above, please initial:
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Do you agree to wear a mask should the health board recommend it? Please respond and initial.
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SCHOOL POLICIES (please read)
Have you read the policies above?
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No
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All above information is true and I agree to abide by studio policies. If yes, sign by typing name of student or parent (if student is minor):
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