Student's Name
*
First Name
Last Name
Student's Gender
*
Female
Male
Non-Binary
Student's Date of Birth
*
MM
DD
YYYY
Parent or Contact Name
*
If this enrollment is for an adult student, please just say "Adult Student".
First Name
Last Name
Credit Card Number
*
Billing Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Location You Would Like to Attend
*
Instrument/Program
*
Please select only one instrument per form. If you would like to enroll this student in more than one instrument, please fill out a separate form for each instrument.
Best Days & Times for Weekly Lessons
*
Preferred Weekly Lesson Length
*
Please enter all that interest you and we will make a recommendation.
What is the student's musical background and experience?
*
What are the student's (or parent's) goals for lessons?
*
How did you hear about us?
*
Internet Search
Referral
Drove By/Saw Your Sign
Facebook
Yelp
Former Student
Family Add-On
Instrument Add-On
Lesson Extension
I acknowledge and understand that I will not be enrolled or charged until an EMA representative contacts me to confirm my schedule. Once I am enrolled, in order to withdraw from lessons and stop payments, I must submit an official withdrawal form by the 15th day of the prior month in which I would like to stop payments.
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