Summer Session 6-Week Music Theory Class Sign Up FormThe Summer Session 6-Week Music Theory Class is on Wednesdays at 1:00pm Student Name * First Name Last Name Email * Parent or student email. This is where communication and important documents will be sent, so please put the best email for contact. Student Phone If student has a phone and will be responsible for communication via text, please add. If you do not want your student to have text contact please leave blank. (###) ### #### Student's Age *If applicable. N/A for adult piano students. Student's Grade *If applicable. N/A for adult piano students. Does the student has any prior music knowledge/experience? * If yes, please provide a brief description below. What level of theory is the student? * If student is a beginner, please put "none". If unsure of level, please provide how long you have studied music theory. Parent/Guardian Name *If applicable. N/A for adult piano students. First Name Last Name Parent/ Guardian Phone Number *If applicable. N/A for adult piano students. (###) ### #### Can I text this number? Yes No Emergency Contact * First Name Last Name Emergency Contact Phone * (###) ### #### Relationship to student? How is the emergency contact related to the student? Does the student have any allergies? If yes, please list below. Payment Plan * *Please note: CASH payments are received in cash, check, Venmo, Cash App, and Zelle. Pay full amount in CASH at the beginning of the Class. Pay full amount in CHARTER FUNDS at the beginning of the Class. Thank you! You will receive an email from me shortly to complete the sign up process for your student!