Student Information Form

2022-2023 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)

    Student First Name:

    Student Last Name:

    Student Date of Birth:

    Street Address Line 1:

    Street Address Line 2:



    Zip Code:


    Home Phone:

    Student Cell Phone:

    Student Email:

    Student Instrument:

    School you attend:

    Grade Attending (2022-2023):

    Residence Area (for grant purposes):

    Age Bracket (for grant purposes):

    Race (for grant purposes):

    Private Teacher's Name:

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

    If yes, Director's Name:

    Father's First Name:

    Father's Last Name:

    Father's Employer:

    Father's Occupation:

    Father's Work Number:

    Father Cell Number:

    Mother's First Name:

    Mother's Last Name:

    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