Private Lesson Registration

Registering as a/an*

Source*

Home Phone*

Address 1*

Address 2

City*

State*

Postal Code*

Country*

Parent/Guardian First Name*

Parent/Guardian Last Name*

Parent/Guardian Email*

Parent/Guardian Cell Phone*

Student First Name

Student Last Name

Student Email

Student Phone Number

Student Date of Birth*

School

Special Needs

Allergies

Notes

We like to share photos and videos of our students on our website, Facebook page, flyers, and newspaper. But first, we need permission from you to use photos and videos of your child for celebrating student accomplishments and promotional purposes. Please fill out the form below according to your preference*

Yes, the St. Joseph Arts Academy has permission to use photos and videos of my child for the purpose of celebrating student achievements or advertising.

No, the St. Joseph Arts Academy does NOT have permission to use photos or videos of my child.

Yes, the St. Joseph Arts Academy has permission to use photos and videos of my child for some advertising resources, but NOT ALL.

Instrument(s)*

Piano

Guitar

Drums

Voice

Ukulele

Bass

Band Instruments

Violin

Early Childhood

Other

Private Lesson Duration*

I've read the above and agree.*

Payment Info*

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