New Student Registration

McCarney Music Studio Registration Form

Student Information

* Indicates required field

Name *

First

Last

Birthdate *

Lesson Length: *

30 Minutes 45 Minutes 60 Minutes

School Grade *

Previous Musical Experience: *

Parent/Guardian Information

Parent/Guardian Name (Primary Contact) *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Primary Phone Number *

Secondary Phone Number *

Email *

Parent/Guardian Name (Secondary Contact) *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Primary Phone Number *

Secondary Phone Number *

Email *

Other: *

Music Instruction Contract

Studio Agreement: *

I have received, read, and agree to the terms of the McCarney Music Studio Policy.

Photo/Video Authorization: *

Includes Does Not Include

permission to take and use photographs and video recordings of my child for promotional or educational purposes on the website and other promotional or educational materials used by the music instructor.

Name Usage *

This includes This Does not Include

Permission to utilize my child's first name in conjunction with the video or photograph.

Submit