Student & Family Enrollment – SmartMatch Form
Family Profile
First Name
Last Name
Email Address
Mobile Phone
Address
City
Postal Code
Referral Info – Let Us Know!
How did you hear about us?
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Facebook
Instagram
Website
Friend
Other
Name of Friend or Other (if applicable)
Preferred Days and Times for Music Lessons
Click the field below multiple times to select all applicable days and times
Monday After School (4:00 - 8:00 pm)
Tuesday After School (4:00 - 8:00 pm)
Wednesday After School (4:00 - 8:00 pm)
Thursday After School (4:00 - 8:00 pm)
Friday After School (4:00 - 6:00 pm)
Saturday Morning (9:00 am - 12:00 pm)
Saturday Afternoon (12:00 pm - 4:00 pm)
Sunday Morning (9:00 am - 12:00 pm)
Sunday Afternoon (12:00 pm - 4:00 pm)
Other availability (e.g., Wed 9–10am)
Student Information
First Name
Last Name
Date of Birth
Preferred Pronoun
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Use First Name
She/Her/Hers
He/Him/His
They/Them/Theirs
Ze/Hir
Other
Which Instrument Do They Want to Play?
Click below to select all instruments the student is excited to learn
Guitar
Piano/Keyboards
Drums
Vocal Coaching/Singing
Ukulele
Bass
Saxophone
Flute
Banjo
Other instruments (e.g., Cello, Drums, Flute)
What is their musical experience?
Which of the following best describes this student’s previous musical education?
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Never played
Less than a year
More than a year and less than three years
More than three years
Do you have anything you would like to let us know?
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