STUDENT APPLICATION FORM PER LESSON Lesson * Lesson of interest Session Length * 30 minute lesson @ $24.00 USD per session 40 minute lesson @ $31.00 USD per session 60 minute lesson @ $42.00 USD per session Name of Student * First Name Last Name Age of Student ONLY APPLICABLE IF APPLYING STUDENT IS UNDER THE AGE OF 18 Parent and/or Guardian Name NON-APPLICABLE IF APPLICANT IS 18 YEARS OF AGE OR OLDER (Required by local and state laws) First Name Last Name Legal Address Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Phone * (###) ### #### Text YES NO ALL INFORMATION SUBMITTED TO QUEEN CITY PERFORMING ARTS IS CONFIDENTIAL AND OF PRIVATE USE ONLY Thank you! Your application has been successfully submitted. An administrator from Queen City Performing Arts will follow up with your submission to verify your interest, preferred scheduled, and payment. God’s richest blessings, Queen City Performing Arts
