* Student's First Name:                                                       

* Student's Last Name:                                                       

* Age:                                                                                 

*School:                                                                              

*Student's Date of Birth:                                                       

* Parent/Guardian's First Name (or "Adult"):                        

* Parent/Guardian's Last Name  (or "Adult"):                       

* Email Address:                                                                

* Phone:                                                                            

Preferred Contact Method:                                                     Phone    Email    Either

* Required Fields

Instrument/s or voice:                                                          

Previous experience on instrument:                                      

Other musical experience: band/choir/orchestra/etc:                 

Other interests:                                                                  

Additional information:                                                         
 

Location interest:   Kennard House    Baker    Brookline High    Devotion    Driscoll   
                              Lawrence    Lincoln    Pierce    Runkle (Old Lincoln)
                                                                 

Please check off available days:  Monday    Tuesday    Wednesday    Thursday    Friday    Saturday    Sunday
 

How did you hear about Brookline Music School?: word of mouth     our website     Social Media: Facebook/Twitter/Youtube


another website / which one?:                                        

print advertisement / where?:                                             

online advertisement / where?:                                          

other/ where?: