Uptown Music Collective - Adult Music Program - New Student Information Form
Please fill out this form to get yourself signed up for the Uptown Music Collective's Adult Music Program.  This provides us basic contact information for communication and enrollment purposes.  All this information is held privately by our Admissions Director.
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First and Last Name of Student: *
First and Last Name of Spouse/Emergency Contact: *
Gender: *
Student's Date of Birth (MM/DD/YR): *
MM
/
DD
/
YYYY
Student Ethnicity: *
This information is only used for demographics about the school for grants and fundraising.
Student's Address: *
Please list your street/mail box number, street name, city/town of residence, state and zip code.  Please use the student's primary address.
What county do you reside in? *
This information is only used for demographics about the school for grants and fundraising.
Student's Home Phone#: *
Please include area code. Ex:000-000-0000
Student's Cell Phone#: *
Please include area code. Ex:000-000-0000
Spouse/Emergency Contact's Cell Phone#: *
Please include area code. Ex:000-000-0000
Student's Email Address: *
Please list your primary email address.  The Uptown Music Collective does the majority of it's communication and it's billing via email.
If you are interested in private lessons, which instrument do you wish to receive lessons on?
Please select 1.  If you are interested in lessons on multiple instruments, please explain this in the "Questions or Comments" section at the bottom. Student's enrolled for private lessons can take 1 class and 2 workshops at no additional charge, see below.
Clear selection
Do you have any previous experience with that instrument? If so, how much? *
What are your preferred days and times for private lessons?
The Uptown Music Collective teaches private lessons Monday-Saturday.  Days and times available for lessons depends on teacher availability.
Are you interested in enrolling for adult based classes and/or workshops?
What styles of music do you listen to? *
Rock, Pop, Blues, Jazz, Alternative or list Artists
Do you have any health or learning issues that we need to be aware of? *
Ex: Allergies, disorders, medical conditions, etc.
Questions or Comments?
Please list any questions you might have and they will be answered in the Admission Director's response.
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