School of Music Registration
Please fill out the form below to register for School of Music
Student First Name
Student Last Name
Gender
Male
Female
Birthdate
Month
January
February
March
April
May
June
July
August
September
October
November
December
Date
1
2
3
4
5
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31
1912
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1919
1920
1921
1922
1923
1924
1925
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1931
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1939
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1941
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1960
1961
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1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
Year
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
Student's School
Student's Grade (Adults enter 13)
Parent(s) or Guardian(s) Please Complete
Parent(s) Name
Email
Cell Phone
Desired Private Instruction
Choose Instrument Below
Piano
Voice
Guitar
Bass Guitar
Drums/Percussion
Saxophone
Flute
Clarinet
Oboe
Trumpet
Violin
Viola
Cello
Desired Lesson Time
Select Lesson Duration
30 Minutes
45 Minutes
60 Minutes
Day of the Week Preferred
Select Your First Choice
Monday
Tuesday
Wednesday
Thursday
Time of Day Preferred
Select Your Second Choice
Monday
Tuesday
Wednesday
Thursday
Second Choice Time of Day Preferred
Previous Years of Instruction
How many previous years of instruction have you had?
None
1 Year
2 Years
3 Years
4 Years
5 + Years
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