Music Academy
Last Name:
First Name:
Name of Student's School:
Student's Grade in School:
Student's Date of Birth:
Semester:
Fall
Please Select
Years Previous Lessions:
Preferred Teacher:
If you are a new student how did you hear about the Music Academy:
Periodically we update pictures on the web site, using photos of our students at recitals, outreach program, the Barnes & Noble Bookfair, or posed shots.
If you will allow the Music Academy to use photos of your student, please complete the following information.
Allow Photos
Do not allow photos
Parent/Guardian Last Name:
Parent/Guardian First Name:
Home Phone:
Cell/Work Phone:
Email Address:
Street Address:
City:
State:
Zip Code: