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La Jolla Music Society's Community Music Center Registration Form
Thank you for your interest in our program. Please fill out the form below and you will be contacted by a La Jolla Music Society staff member.
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* Indicates required question
Instrument
Your answer
STUDENT INFORMATION
Last Name
*
Your answer
First Name
*
Your answer
Middle Name
Your answer
Student Email
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
High School Graduating Year
*
Your answer
Race/Ethnicity
American Indian/Native American
Asian
Black/African American
Hispanic/Latino
White/caucasian
Pacific Islander
Other:
SCHOOL INFORMATION (2020-21)
School Name
*
Your answer
Grade Level
*
Your answer
Do you participate in your school's instrumental music program?
*
Yes
No
If yes, which ensemble?
Your answer
Music Instructor(s):
Your answer
If no, please provide the reason:
Your answer
Other extracurricular activities:
Your answer
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