Registration

Parent's First Name *

Parent's Last name *

Email Address *

Phone *

Address *

Please choose a semester *

Fall (August-December) Spring (January-April) Summer (June-July)

Student 1

First Name *

Last Name *

Age *

New/Returning Student *

New Student Returning Student

Desired Lesson Type *

Online Piano 30-minute Remote Piano 45-minute Remote Piano 30-minute In-Person Piano 45-minute In-Person Piano 30-minute In-Person Voice 45-minute In-PersonVoice 30-minute In-PersonGuitar 45-minute In-PersonGuitar

Preferred Instructor *

No Preference Portia Davis (Piano) Rebekah Lipscombe (Piano) Sarah Pigott (Voice) Michael Rushing (Piano) Jimmy Turner (Guitar) Morgan Vann (Piano)

Years of Previous Study *

0 1 2 3 4 5+

Choose Yes to register a sibling or for more lessons

Yes No

Student 2

First Name

Last Name

Age

New/Returning Student

New Student Returning Student

Desired Lesson Type

Preferred Instructor

No Preference Portia Davis (Piano) Rebekah Lipscombe (Piano) Sarah Pigott (Voice) Michael Rushing (Piano) Jimmy Turner (Guitar) Morgan Vann (Piano)

Years of Previous Study

0 1 2 3 4 5+

Choose Yes to register a sibling or for more lessons

Yes No

Student 3

First Name

Last Name

Age

New/Returning Student

New Student Returning Student

Desired Lesson Type

Online Piano 30-minute Remote Piano 45-minute Remote Piano 30-minute In-Person Piano 45-minute In-Person Piano 30-minute Private Voice (ages 8+) 45-minute Private Voice (ages 8+) 30-minute Private Guitar (ages 7+) 45-minute Private Guitar (ages 7+)

Preferred Instructor

No Preference Portia Davis (Piano) Rebekah Lipscombe (Piano) Sarah Pigott (Voice) Michael Rushing (Piano) Jimmy Turner (Guitar) Morgan Vann (Piano)

Years of Previous Study

0 1 2 3 4 5+

Preferred lesson times (private lessons only)

Additional needs, information, or circumstances

Mississippi College Department of Music

Community

Student 1

Student 2

Student 3