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Student Enrollment Form

Today's Date

Month

Day

Year

First name

Last name

Email

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Birthday*

Month

Day

Year

Grade*

Have you studied piano?*

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If yes, how long?

If yes, with whom?

Have you studied voice?*

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No

If yes, how long?

If yes, with whom?

Age*

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Address

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OPENING HOURS

Open 7 days a week, by appointment only. Lessons available upon request.

MILLER MUSIC STUDIOS

158 Commonwealth Ave.

Middletown, NY 10940

Tel: 845-342-2206

Text Cell: 845-741-3145

Email: info@millermusicstudios.com

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