Family & Student SmartMatch Enrollment Form
Family Profile
Family Contact's First Name
Family Contact's Last Name
Family Contact's Email
Additional Family Contact's Email (if applicable)
Family Contact's Mobile Phone
Address
City
Province or State
Postal or Zip Code
Country
Select country...
United States
Canada
United Kingdom
-------------
Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia, Plurinational State of
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, the Democratic Republic of the
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran, Islamic Republic of
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia, the former Yugoslav Republic of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Moldova, Republic of
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russian Federation
Rwanda
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Tanzania, United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela, Bolivarian Republic of
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Referral Information
How did you hear about us?
Select
Facebook
Instagram
Website
Friend
Other
Name of Friend or Other (if applicable)
Preferred Days and Times for Music Lessons
Select all applicable day and time options by clicking on the field below multiple 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 day and time options not listed (if applicable) (e.g., Wednesday [9:00 am - 10:00 am])
Student Profile
First Name
Last Name
Date of Birth
Preferred Pronoun
Select
Use First Name
She/Her/Hers
He/Him/His
They/Them/Theirs
Ze/Hir
Other
Instrument(s) for Instruction
Select all applicable instruments this student is excited to learn by clicking on the field below multiple times.
Guitar
Piano/Keyboards
Drums
Vocal Coaching/Singing
Ukulele
Bass
Other
Other Instrument(s) (if applicable) (e.g., Cello, Violin, Flute, etc.)
Musical Experience and Availability of Instrument(s)
Which of the following best describes this student’s previous musical education?
Select
Never played
Less than a year
More than a year and less than three years
More than three years
Does this student have an instrument to use during their lessons?
Select
Yes - We own the appropriate instrument(s)
No - We would be interested in purchasing the appropriate instrument package(s)
We would be interested in renting the appropriate instrument(s)
We have other options and we will have the appropriate instrument(s) available for our lessons
Genre(s) of Music to Investigate
Select all genres of music this student is excited to study by clicking on the field below multiple times.
Pop
Rock/Blues
Country/Folk
Hip Hop/ R&B
Jazz
Other
Other Genre(s) (if applicable) (e.g., Heavy Metal, Classical, Techno, etc.)
Method of Lesson Delivery and Additional Student Information
How/Where will this student be taking lessons?
Select
In this student's home
Online
Hybrid - A mix of in-person and virtual lessons
What else should we know about this student?
Remove
Add Another Student
Submit