APPLICATION FORM
NAME OF STUDENT_____________________________________________________________________
NAME OF PARENT______________________________________________________________________
ADDRESS_____________________________________________________________________________
PHONE NUMBER(S)_____________________________________________________________________
EMAIL________________________________________________________________________________
STUDENT AGE/GRADE_____________________ STUDENT BIRTHDATE__________________________
PRIOR MUSIC LESSONS? YES NO
IF SO, WHAT INSTRUMENTS, HOW LONG AND WITH WHO (IF YOU ARE COMFORTABLE SHARING)?_________________________________________________________________________________________________________________________________________________________________
TYPE OF CLASS YOU ARE SIGNING UP FOR___________________________________________________
TUITION PAYMENT METHOD PREFERED (Circle One): Year Semester Month
Which other classes might you be interested in the future?
Music Play (0-3) String Instrument Class (6+) Adult Music Classes
Please tell me anything about the student’s musical environment, interest in lessons, special needs they might have, or anything else you might like to share._________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
I have read the policies and agree to abide by them:
Sign _____________________________________________ Date _________________ Print ______________________________________________
Please print this and fill it out if you are interested in lessons and turn in with your registration fee.
Can be sent to: Renee Knutson 4031 County Road N, Florence, WI 54121 or given in person.
I have a Facebook page: From the Inside Out Music Studio. Please Like that page. I’ll use it to communicate general information to students.
I also have a website: http://insideoutmusic.mymusicstaff.com/Home. Please visit for policy information, to contact me or to share with your freinds and family.