Student Information Complete all applicable information, a * denotes a required field.
Student's Name *
Male Female
Your Name * If you are an adult student, list your name here.
Student's Date of Birth
Student's Home Address * Street, City/Town, State, Zip Code
Is off-street parking available for the teacher? In-Home Lessons Only Yes No
Is on-street parking available for the teacher? In-Home Lessons Only Yes No
Student's Email Address Adult students only, we do not email students under the age of 18.
Student's Home Phone Number Adult students only, we do not call students under the age of 18.
Student's Cell Phone Number Adult students only, we do not call students under the age of 18.
Parent Information Complete all applicable information, a * denotes a required field. Adult students may skip this section.
Mother's Name
Mother's Home Address Street, City/Town, State, Zip Code
Mother's Home Phone Number
Mother's Cell Phone Number
Mother's Work Phone Number
Mother's Email Address
Father's Name
Father's Home Address Street, City/Town, State, Zip Code
Father's Home Phone Number
Father's Cell Phone Number
Father's Work Phone Number
Father's Email Address
Emergency Contact Information In case of an emergency, whom should be contacted in the event a parent cannot be reached?
Special Conditions or Considerations Describe any special conditions or considerations MNA Directors and Teachers should be aware of.
Your Music Education What instrument(s) are you interested in studying? Check all that may apply.
Drums, Percussion Classical Guitar Audio Engineering, Recording
Piano Acoustic Guitar Music Technology, Production
Voice Electric Guitar Song Writing, Composition
Brass Violin Music Theory, Arranging
Woodwinds Viola
Other
Bass Guitar Cello
Our Music Instruction Programs Choose one of the following Music Instruction Programs.
Program 1: Quarter Notes Our basic Early Childhood Music Lessons For students
Program 2: Half Notes Includes Program 1:
Adult Music Lessons For students ages 18
Program 3: Whole Notes Includes Program
Summer Music Lessons You create your own
Program 4: East Brunswick Private music
I would like to enroll for a semester only.
I would like to enroll for the school year.
I would like to enroll for a month-to-month comittment.
Choose Your Weekly Lesson Length
30-Minute Lessons* 60-Minute Lessons
45-Minute Lessons 75-Minute Lessons
*30-Minute in-home music lessons are only available for our Early Childhood Music Lessons Program. Students studying
Preferred Lesson Day & Time List the day(s) of the week and time(s) that are most convenient to have your weekly music lessons.
1st Choice*
2nd Choice*
3rd Choice*
*If your preferred lesson day(s) and time(s) is(are) not available you can remain on our waiting list, we'll reach out to
When would you like to begin your music lessons?
Immediately, as soon as possible.
At the beginning of the next Semester (Fall, Winter, Spring, Summer).
At the beginning of MNA's upcoming school year.
I would prefer to start on a specific date, which is
Student's Musical Background
Briefly describe, if any, the student's musical background or previous music experience.
Briefly describe, if any, specific musical goals and aspirations.
Describe, if any, learning or educational disabilities.
Our Music Teachers If you would like to request a specific music teacher to study with, enter your preferred music
Academy Policies I understand to ensure students receive the most comprehensive and well-rounded music education, Academy Policies
Adult Student or Parent's Name
Adult Student or Parent's Initials
Registration Submission Thank you for registering with Music Notes Academy. You will be contacted by the Director to discuss
In-Home Private Music Lessons Student Registration $49
