Fine Arts Registration
Please fill in the form below. NOTE: by submitting this information you recognize this is only a request for registration and does NOT guarantee placement, reserved spot, or schedule preference. We will contact you with any next steps. Thank you.
Student Information
Student Name
*
First Name
Last Name
Male
Female
Returning Student?
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YES
NO
Address
Street Address
Street Address Line 2
City
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Alabama
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District of Columbia
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Louisiana
Maine
Maryland
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Michigan
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Montana
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North Carolina
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Ohio
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Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Primary Phone
-
Area Code
Phone Number
Secondary Phone
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Area Code
Phone Number
Primary E-mail
*
Student Date of Birth
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Month
-
Day
Year
Date Picker Icon
Employer or School
Grade/Position
Referred by
Church Member?
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YES
NO
If YES, what church?
Contact Information
Father's Name
First Name
Last Name
Father's Phone Number
-
Area Code
Phone Number
Mother's Name
First Name
Last Name
Mother's Phone Number
-
Area Code
Phone Number
Emergency Contact
First Name
Last Name
Relationship
Parent, Spouse, Guardian, etc.
Emergency Contact Phone Number
-
Area Code
Phone Number
Student Experience and Preference
Music/Art Level:
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Beginner
Intermediate
Advanced
List previous experience
I'm interested in: (check all that apply)
Piano
Violin
Voice
I am applying for the:
Fall Semester
Spring Semester
Summer Semester
4-Weeks Trial Session
Lesson Choice #1
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Monday
Tuesday
Wednesday
Thursday
Friday
Please indicate your choice of lesson day
Lesson Choice #2
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Monday
Tuesday
Wednesday
Thursday
Friday
Please indicate your choice of lesson day
Lesson Choice #3
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Monday
Tuesday
Wednesday
Thursday
Friday
Please indicate your choice of lesson day
Lesson Choice #4
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Monday
Tuesday
Wednesday
Thursday
Friday
Please indicate your choice of lesson day
Preferred Instructor
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Jackie Jarvis
Allison Wright
Preferred Start Time
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Select Session Time (per session)
30 min per session
45 min per session
60 min per session
Financial Information
Preferred Payment Method
Payment by Check
Automatic Bank Draft
Scholarship
I am interested in scholarship information
Group Class
I am interested in group classes.
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