The Music Academy
Bring Music to Life 386-438-5912

Registration Form

Music Lesson Registration Form

Please fill out the form below to register for music lessons

Student's Info
Student's Name *
Student's Name
Date of Birth *
Date of Birth
Mailing Address *
Mailing Address
Lesson Time
Parent/Guardian Info
Mother's Name *
Mother's Name
Mother's Phone *
Mother's Phone
Father's Name *
Father's Name
Father's Phone *
Father's Phone
Instrument
Section
Family Musicality
Additional Info