New Student Registration

Welcome to my studio! I'm excited to start working with you and exploring music together! Please take a moment to fill out this form so that I have your information and that you understand all studio policies and procedures.

Student Information

* Indicates required field

Student Name *

First

Last

Prononuns (optional) *

Age *

School/Grade *

Parent/Guardian #1 Contact Information (Main contact person)

If you are an adult student, please put your main contact info here.

Name *

First

Last

Pronouns (optional) *

Email *

Cell Phone *

Home Phone *

Home Address (for billing purposes) *

Line 1

Line 2

City

State

Zip Code

Country

Do you consent to having your contact information (email and phone only) available to other students in my studio for lesson switching purposes? Your information will displayed on a password-protected page on my website that is not accessible to the general public. *

Yes Only my phone number Only my email Please do not share my information at all

Parent/Guardian #2 Contact Information (Secondary contact person)

Please fill this out if the parent/guardian bringing the student to/from lessons is different from the parent/guardian who is the main communication contact. If you are an adult student you can skip this.

Name *

First

Last

Pronouns (optional) *

Email *

Cell Phone *

Home Phone *

Home Address (not required if the same as above)) *

Line 1

Line 2

City

State

Zip Code

Country

Yes Only my phone number Only my email Please do not share my information at all

Is there anything you'd like me to know about you/your child in regards to their learning style, behavior, preferences etc.? (optional) *

Studio Policies

Please view my current studio policies here.

I have read and understand all studio policies and procedures. *

Yes

Submit