Student Name *

First Name

Last Name

Student Birthday *

MM

DD

YYYY

Parent/Guardian Name *

If an adult student, enter your own name here.

First Name

Last Name

Additional Parent/Guardian Name

(optional)

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Main/Home Phone

(###)

###

####

Parent/Guardian Cell Phone *

If an adult student, enter your cell phone here.

(###)

###

####

Student/Child Cell Phone

(optional)

(###)

###

####

Lesson Reminders

Please indicate how you'd like lesson reminders delivered. Studio newsletters and other important information will always be sent to parent/guardian emails. (Choose all that apply.)

No notifications, please.

Please text the parent cell phone provided.

Please email the parent email provided.

Please text the student cell phone provided.

Please email the student email provided.