Today's Date
Student Information:
Student 1 Last Name
Student 1 First Name
If under age 18:
D.O.B. (MM/DD/YYYY)
Age and Grade
School Attending
Fill out below for any additional family members applying. If only one is applying skip to “Mailing address”
Student 2 Last Name
Student 2 First Name
If under age 18 (Student 2):
D.O.B. (MM/DD/YYYY)
Age and Grade
School Attending
Mailing Address (1)
Mailing Address (2)
City
State Zip
State ZipHome Phone
Work Phone (Adult)
Cell Phone (Adult)
Parent/Guardian Information:
Guardian 1 Name
Guardian 1 Work or Cell Phone
Guardian 2 Name
Guardian 2 Work or Cell Phone
E-Mail will be the primary way of keeping in touch. Please list the e-mail addresses you check most often:
E-Mail (For Adult Students)
Guardian 1 E-Mail
Guardian 2 E-Mail
Student E-Mail
Personal Questions
The following questions will help to get to know you better:
Please describe your dance, music and/or theatre background (including past music or dance lessons, related school classes –band or choir, productions, etc.)
What other activities outside of school and/or work are you involved in, that could challenge your ability to practice for your lessons at least 2 hours a week?
Do you understand that students in The Spotlight Studio will be required to participate in a cabaret showcase each semester (this may be waived for adults)?
What is the best time for your lesson?
Are you willing to go on a wait list?
In addition to lessons, are you
interested in performing opportunities
in either related classes,
plays or musicals?
WEB PHOTO PERMISSION:
For the educational purposes of The Spotlight
Studio, I do give Dolly Stevens and The Spotlight
Studio permission to publish photographs that will
include me or my child participating in The Spotlight
Studio on the studio’s website,
www.thespotlightstudio.com.
I would rather my or my child’s photograph NOT be
used on the studio’s website.
The Spotlight Studio • P.O. Box 92 • Purcellville, VA 20134 • 540.338.2690
© 2006-2007 The Spotlight Studio. All rights reserved.
