Today's Date *

MM

DD

YYYY

Student's Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number *

(###)

###

####

Emergency Phone Number *

(###)

###

####

Name of Parent or Guardian (if applicable)

First Name

Last Name

Areas of Interest *

Voice lessons

Media Release *

I acknowledge that class sessions, recitals, and concerts may be videotaped or photographed for educational, promotional, liability or any other reason and I grant consent for such activity and its use for social media, promotional material, etc. for the Music Studio’s purpose.