Pensacola Music Studio

Student Registration

Student Information First Name: *
Last Name: *
Address:

City:
State:
Zip:
Home Phone: *
Cell Phone:
Email: *
Birthdate:
Hobbies:

If Student is under 18, Please enter the following information: Parent Name:
Work Phone:
School Name:
Grade:

Lesson Information

Lesson Type: (Select all that apply)

Piano Voice Speech

Time Slot:

30 Minutes 45 Minutes 1 Hour Other

Desired Time:

Have you taken lessons before?

Yes No

If Yes, how long and what type?

How did you hear about Pensacola Music Studio?

Comments or Questions:

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