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Iowa School of Rock
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Iowa School of Rock Registration
Iowa School of Rock
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Student Last Name
Student First Name
Mother's Name
Father's Name
Mother's cell#
(xxx-xxx-xxxx)
Father's cell#
(xxx-xxx-xxxx)
Mother's work
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Father's work
(xxx-xxx-xxxx)
Email
Alternate Email
Street Address
City
State
Zip
Home phone
(xxx-xxx-xxxx)
Student Birth Date
(mm/dd/yyyy)
Any medical conditions
we should be aware of?
What instrument(s) do you play, including voice?
How long have you been playing?
Favorite music styles (select all that apply)
Classic Rock
Alternative
Country
Jazz
Blues
Reggae
Originals
Dance
r&b/hip hop
Acoustic
Praise
Other (Please write below)
Other
How did you hear about Ames Music Studios?
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Referral-Family Member
Referral- Friend (Please give name below)
Referral- Business or Teacher (Please give name below)
Other (Please write below)
Other
Currently in lessons?
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If yes, Teacher/Where?
Agreement to terms
I have read and agree to the Iowa School of Rock
terms
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