Student Information Form

2021-2022 Student Information Form

Please complete all fields below.
This is for all students – new and returning – for both Ethos Ensembles and Ethos Music Academy (beginning group lessons)

    First Name:

    Last Name:

    Student Date of Birth:

    Gender:

    Street Address Line 1:

    Street Address Line 2:

    City:

    State:

    Zip Code:

    County:

    Home Phone:

    Student Cell Phone:

    Student Email:

    Student Instrument:

    School you attend:

    Grade Attending (2021-2022):

    Residence Area (for grant purposes):
    RuralUrban

    Age Bracket (for grant purposes):
    6-1213-19

    Race (for grant purposes):
    AsianBlackHispanicWhiteOther

    Private Teacher's Name:

    Is the student in his/her School Band/Orchestra/Choir?
    YesNo

    If yes, Director's Name:

    Father's First Name:

    Father's Last Name:

    Father at same address as student?
    YesNo

    Father's Employer:

    Father's Occupation:

    Father's Work Number:

    Father Cell Number:

    Mother's First Name:

    Mother's Last Name:

    Mother at same address as student?
    YesNo

    Mother's Employer:

    Mother's Occupation:

    Mother's Work Number:

    Mother Cell Number:

    Preferred Email address for Billing and Important Information:

    My family and I have read the Ethos Student/Parent Handbook found under the Information Tab at www.EthosMusic.net. We agree to the COVID 19 Protocols in place for Fall 2021 (listed on the Home Page of EthosMusic.net), including the wearing of masks at all Ethos events.