Enrollment Form Student Name * First Name Last Name Student Email * Student Phone (###) ### #### Student Age MM DD YYYY Student Gender Male Female Prefer Not To Say Goals What are your musical goals? Previous Experience Does the student have any previous experience? If yes, please share. Parent/Guardian Name 1 If child under 18 please fill out. First Name Last Name Parent/Guardian Email 1 Parent/Guardian Phone 1 (###) ### #### Parent/Guardian Name 2 If student is under 18 and lives with more than 1 parent/guardian. First Name Last Name Parent/Guardian Email 2 Parent/Guardian Phone 2 (###) ### #### Piano Classes Intermediate Pianist Beginner Pianist Vocal Coaching Beginner Vocal Coaching Intermediate Vocal Coaching Class Type Preference In-Person Virtual Hybrid How Did You Hear About 4th Avenue Music? Social Media Friend Family Flyer Other Start Date * What is your earliest start date? Thank you!
