Musician's Name *

First Name

Last Name

Skill level

Beginner

Intermediate

Advanced

Musician's Birth Date *

MM

DD

YYYY

Parent/Guardian Name *

First Name

Last Name

Parent/Guardian's Phone

(###)

###

####

Emergency Contact Name *

First Name

Last Name

Emergency Contact's Phone *

(###)

###

####

Authorization *

I authorize that the information I am submitting is true. I wish to enroll in ROC Star Academy programming. I have read and understand the cancellation, tuition, and student conduct policies of ROC Star Academy (available in website footer), and by checking this box agree to them. I give permission for publication of photos, videos, and recordings of the enrolled student at rehearsals or performances.