Student Information (Adult or Minor)

List only one student per registration.

First Name Last Name

Birthdate/Age/Grade (if minor)

School/College Attending (if applicable)

Does the student have any special circumstances of which the EMU CMA staff should be made aware?

History of musical experiences:

Musical goals:

Private Instrument/Voice (if applicable) Bassoon Cello Clarinet Double Bass Euphonium Flute Guitar (Acoustic) Harp Harpsichord (Piano Prerequisite) Horn Oboe Organ (Piano Prerequisite) Percussion Piano Saxophone Trombone Trumpet Tuba Viola Violin Voice

Scheduling for private lesson (if applicable; check all that apply)

I would like a lesson just before group class meets.
I would like a lesson just after group class meets.
I would like to list my available times for lessons as follows:

Contact Information for Adult Student/Workshop Registrant/Parents/Guardians

For minors; if an adult student, please list your own contact information here.

Parent 1 (or Adult Student)

First Name Last Name

Address

City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip

Home Phone Work Phone

Cell Phone Email

Parent 2

First Name Last Name

Address

City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip

Home Phone Work Phone

Cell Phone Email

Guardian / Nanny

First Name Last Name

Home Phone Work Phone

Cell Phone Email

Referral Information

How did you hear about us?

Available Courses

Select the course(s) below for which you wish to register. Descriptions and meeting times can be found under the various age categories listed on the CMA Home Page.

All EMU CMA website content subject to change.

Please review the entire form for accuracy. Once validated, please click submit. You should be presented with a confirmation page.