SM+ARTs Academy Student Registration

Please fill out this form and click submit.

Student Information

Name of Student

Age of Student

Has the student ever had previous piano lessons or any other music related experiences? (Ex. Chorus, Handbells, Band, etc.)

Please select one option.

Yes No

If yes, please briefly explain (ex. how long, what method(s), ability to read music)

Does the student have a piano or keyboard at home to practice on?

Please select one option.

Yes No

Parent / Guardian Information (if student is under the age of 18)

Name of Parent/Guardian

Parent/Guardian Email

This address will receive a confirmation email

Parent/Guardian Cell Phone

Home Address

Please Note: If your student is under the age of 15, a parent or guardian must remain in the room or nearby during the lesson. Lessons are scheduled back-to-back, so we kindly ask that you arrive on time and be considerate of those before and after your child’s session. Your cooperation helps everything run smoothly for all families involved.

What specific outcomes do you hope to see as the student or in your student, as they/you participate the Music Academy? (For example: growth in spiritual maturity, development of musical skills, stronger social connections, deeper understanding of worship and the Bible, improved discipline or confidence, etc.)

What day/time frame is the student available for lessons?

Please select one option.

Tuesday Afternoon Wednesday Afternoon Thursday Afternoon Friday Morning Friday Afternoon

Does the student have any learning needs, allergies, or other considerations we should be aware of?

$30 Application Fee (Non-Refundable)

How would you like to pay for your application fee?

Please select one option.

Cash Check Credit Card

If paying by credit card, enter $30 in to the

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

Please fill out this form and click submit.

SM+ARTs Academy Student Registration

Description

Please Fix the Following