Fine Arts Registration

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?
Address

Street Address

Street Address Line 2

City State

Zip Code
Primary Phone

Area Code Phone Number
Secondary Phone

Area Code Phone Number
Primary E-mail *
Student Date of Birth

Month Day Year
Employer or School
Grade/Position
Referred by
Church Member?
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:
List previous experience
I'm interested in: (check all that apply)

Guitar Piano Trumpet Violin Voice
I am applying for the:

Fall Semester Spring Semester Summer Semester
Lesson Choice #1
Please indicate your choice of lesson day
Lesson Choice #2
Please indicate your choice of lesson day
Lesson Choice #3
Please indicate your choice of lesson day
Lesson Choice #4
Please indicate your choice of lesson day
Preferred Instructor
Preferred Start Time

: Hour Minutes 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.
Should be Empty:

Fine Arts Registration

Student Information

Contact Information

Student Experience and Preference

Financial Information