Student's Name *

First Name

Last Name

Date of birth

MM

DD

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mother's Name

First Name

Last Name

Phone *

(###)

###

####

Father's Name

First Name

Last Name

Phone

(###)

###

####

Monday

9:00

10:00

10:30

11:00

11:30

12:00

12:30

1:00

1:30

2:00

2:30

3:00

3:30

4:00

4:30

5:00

5:30

6:00

6:30

7:00

7:30

Tuesday

9:00

9:30

10:00

10:30

11:00

11:30

12:00

12:30

1:00

1:30

2:00

2:30

3:00

3:30

4:00

4:30

5:00

5:30

6:00

6:30

7:00

7:30

Wednesday

9:00

9:30

10:00

10:30

11:00

11:30

12:00

12:30

1:00

1:30

2:00

2:30

3:00

3:30

4:00

4:30

5:00

5:30

6:00

6:30

7:00

7:30

Thursday

9:00

9:30

10:00

10:30

11:00

11:30

12:00

12:30

1:00

1:30

2:00

2:30

3:00

3:30

4:00

4:30

5:00

5:30

6:00

6:30

7:00

7:30

Friday

9:00

9:30

10:00

10:30

11:00

11:30

12:00

12:30

1:00

1:30

2:00

2:30

3:00

3:30

4:00

4:30

5:00

5:30

6:00

6:30

7:00

7:30

Saturday

9:00

9:30

10:00

10:30

11:00

11:30

12:00

12:30

1:00

1:30

2:00

2:30

3:00

3:30

Do you have a sibling in the program?

yes

no

If you have multiple children in the program, would you like their lessons scheduled back to back?

yes

no

I have read the studio policies *

yes

I consent to my child's photo being used online, in newsletters, and for marketing purposes. *

yes

Would you like your contact information (phone number and email address) shared amongst our studio for the purpose of lesson swapping?

Mom's contact info

Dad's contact info

Please do not share my contact info