Returning Student's Name *

First Name

Last Name

Parent/Guardian Name *

First Name

Last Name

Cell Phone *

(###)

###

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Emergency Contact *

First Name

Last Name

Emergency Contact Cell Phone *

(###)

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Earth Song Creative Arts has my permission to use photos and/or videos of my student(s) on the studio website, social media accounts, or other publications. *

Yes

No

Other

I have read the 2025-2026 Studio Policies and agree to all the terms as written.

Agreed

I have read the 2025-2026 Cancellation Policy and agree to all the terms as written.

Agreed

I have read the 2025-2026 Monthly Tuition Policy and agree to all the terms as written. *

Agreed

I understand that I must register for an Acuity Scheduling Client Account in order to view/cancel/reschedule my lessons. *

I already have an account.

I've used Acuity before, but I'm not sure if I have an account. (Jess will send instructions for registering after scheduling is complete.)

I will register. (Jess will send instructions for registering after scheduling is complete.)