Music School Enrollment Form

Name

First NameLast Name

Date of Birth

Date

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Name (if student is under 18)

First NameLast Name

Parent/Guardian Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Parent/Guardian Email Address

example@example.com

Instrument(s) of Interest

Program Type

Preferred Lesson Duration

Previous Music Experience

Goals for Music Lessons

Any specific areas of focus or repertoire interests

Additional Comments or Special Requests

Preferred Lesson Day(s)

Preferred Lesson Time(s)

Emergency Contact Name

First NameLast Name

Relationship to Student

Emergency Contact Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Terms and Conditions:

I, [Student/Parent/Guardian Name], hereby enroll in music lessons at [Music School Name] and agree to abide by the terms and conditions outlined by the school. I understand that payment is due in advance for each lesson or session and that any cancellations or rescheduling must be made with [Music School Name] according to their policies.

Student/Parent/Guardian Signature

Date Signed

Date

Music School Enrollment Form

Instrument and Program Selection

Experience and Goals

Emergency Contact Information