Student Name *

First Name

Last Name

Parent/Guardian Name

(Required if under 18)

First Name

Last Name

Date of Birth

(Required if under 18)

MM

DD

YYYY

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Which program(s) are you interested in? *

(Check all that apply.)

Rock Band

Jazz Band

String Ensemble

Percussion Ensemble

1 + 1 Ensemble (Ukulele, Guitar, Piano, Mandolin, Banjo & Kitchen Sink)

Studio Policy Bullet Points: *

• Please arrive punctually and prepared for your lesson. • You must contact your instructor at least 24 hours BEFORE your lesson to report a cancellation or to reschedule or you may forfeit the lesson for that week. 24-hour notice is not required for illness or emergency, please call as soon as you can. • If weather conditions do not permit safe travel at the time of your session, lessons may be made up later or conducted remotely. Contact your instructor if you are unsure.

I have read and understand the above policies. More information is provided in the link at the bottom of the page.

Photo Release *

I give Music Education Centers (MEC) permission to use photographic and/or video documentation of myself or my child for promotional and educational purposes including social media, internet publishing, staff training, and as an educational tool for other professionals.*

Yes

No