Enrollment Form

Once you submit this form, a GMA, SMA or LCA desk staff member will contact you to set up your lesson day and time.

You will not be charged until we have confirmed a day and time and let you know what your total will be.

Lesson Location:

Account First Name

Account Last Name

Secondary Account Name

Student First Name

Student Last Name

Student Instrument

Street Address

Address Line 2

City

State

Zip Code

Phone Number

Email Address

Cell Phone:

Home/Other Phone:

School

Grade

Age

Birthday (Month, Day, Year)

Gender

How did you hear about us?

Promo Code:

Do you/does your student have any special needs?

Image Waiver:

At the Guilderland and Scotia Music Academies and Latham Center for the Arts we like to use images, and recordings of our students in our monthly newsletter, for student of the month, in Facebook posts, and in other Marketing tools.

I give permission for the image, name, and audio and/or video recording of myself / my student to be used by the Guilderland or Scotia Music Academy. Parents will always be notified when an image is selected for use.

I do not give permission for the image, audio and/or video recording of myself/my child to be used by the Guilderland or Scotia Music Academy or Latham Center for the Arts.

Signature

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