Student Registration Form - Tucson Youth Music Center

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TYMC Student Registration

Please fill out the registration form below. Once submitted, you will be presented with the next form to fill out. Please be advised we need all forms to be completed in order to process your application. Once received, we will review and reach out to you just as soon as we possibly can.

Date
MM slash DD slash YYYY
Child's Name*
First Last
Date of Birth*
MM slash DD slash YYYY
Gender
- Male
- Female
Student's Cell Phone*
Student's Email
Name of school (attending in Sept.)
Grade (in Sept.)
Parent/ Guardian Name*
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Preferred Phone*
Contact Email
(2) Parent / Guardian Name*
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Preferred Phone*
Contact Email
Emergency Contact #1*
First Last
Cell Phone*
Phone #2*
Emergency Contact #2*
First Last
Cell Phone*
Phone #2*
What instrument is your child interested in learning?
Please check the ethnicity that best describes the child
(this information will ONLY be used for statistical purposes. It will NOT be used as a basis for admission or any other discriminatory manner)
- Latino/Latina
- African American
- Asian
- Pacific Islander
- Caucasian/White
Does your child have special circumstances or needs of which we should be aware?
- Yes
- No
Please describe*
Has your child ever received music lessons?
- Yes
- No
Which instrument(s)?
For how long?*
Lesson type
- Group Lessons
- Private Lessons
- Tucson Youth Music Center
Does the child have his/her own instrument? (If not, we will be able to provide one, on loan)*
- Yes
- No
TYMC Chorus Enrollment
- Please ALSO enroll my child in the Tucson Youth Music Center chorus
- Please ONLY enroll my child in the Tucson Youth Music Center chorus
How did you learn about The Tucson Youth Music Center?
*
I have read the application and would like to apply for a music scholarship for my child. Tucson Youth Music Center does not discriminate on the basis of race, color, gender, religion, national origin or ethnicity in students admission or any program it administers.
Signature*
Comments
This field is for validation purposes and should be left unchanged.

Contact Us

[email protected]
Support TYMC
Financials
Traducción al español
520-882-6653

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