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Student Name

First Name

Last Name

Date of Birth

YYYY

School Attending

Medical Information

Please list any allergies, disabilities, any medical information that your instructor should know about.

Parent/Guardian

If student is under 18

First Name

Last Name

Phone

(###)

###

####

Parent/Guardian #2

First Name

Last Name

Phone #2

(###)

###

####

Email #2

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact

First Name

Last Name

Relationship to Student

Phone

(###)

###

####

Lesson Subject & Availability

Instrument

Lesson Duration

Lesson Location

Comments & Questions

Please let us know : - Your availability and preferred lesson times - If you would like to learn a second instrument - Any questions or comments you would like to add

How did you hear about us?

Promo Code

About Us Register Now Contact Us

If you are ready to get started with music lessons please fill out our online registration form below

Our team will get back to you with our availability and your lesson start date and we can answer any questions you might have.

For multiple students under one household (siblings/family members) please fill out a separate form for each student

Aria Music Academy

Camp Rock Registration Payment accepted via cash, e-transfer, cheque, or online via PayPal:

About Us Register Now Contact Us

AriaMusicAcademy@outlook.com