Name of Student Gender: Male Female
Grade Level (if applicable)
Name(s) of Parent/Guardian
Student Cell Phone #
Parent/Guardian Phone #
Parent/Guardian Work Phone #
Emergency Contact Name
Emergency Contact Phone #
City, State, Zip
Medical Plan/Insurance #
Please describe any medical conditions:
How did you hear about HRA?
Friends that might like HRA Studios...
What times are you most available?
Mondays 4:00pm-6:00pm 6:00pm-8:00pm none
Tuesdays 4:00pm-6:00pm 6:00pm-8:00pm none
Wednesdays 4:00pm-6:00pm 6:00pm-8:00pm none
Thursdays 4:00pm-6:00pm 6:00pm-8:00pm none
Fridays 4:00pm-6:00pm 6:00pm-8:00pm none
Saturdays 4:00pm-6:00pm 6:00pm-8:00pm none
Does the student want to sing? yes no
What instrument(s) will the student play?
guitar bass keyboard drums horn other
Will you be joining a band with other friends? Please list them:
Does the band already have a name? What is it?
What is your style of music
Who are your favorite bands? Please list them:
What level is the student?
rare (just starting) medium (getting the hang of it) well done (all set to take over the world)
Do you have your required instrument/equipment? yes no
Does the student want to learn filmmaking? yes no
Does the student want to learn music production? yes no
Do you have other hobbies/talents you would like to explore at HRA? Please list them:
• Class Registration
• 2012 Camp Registration
• Pay Your Bill
• Upcoming Events