Hollywood Rock Academy

student's name:

gender: male female         grade:

parent/guardian name:

phone #:

work phone #:

emergency contact phone #:

your email address:

street address:

city.state   zip

medical plan/insurance #:

please describe and medical conditions:

how did you hear about HRA?

friends that might like hollywood rock academy...

What times are you most available?
monday 4:00-6:00   6:00-8:00
tuesday 4:00-6:00   6:00-8:00
wednesday 4:00-6:00  6:00-8:00
thursday 4:00-6:00   6:00-8:00
friday 4:00-6:00   6:00-8:00
saturday 10:00-12:00  12:00-2:00  2:00-4:00

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? list them:

does the band already have a name? what is it?

what is your favorite style of music?

who are your favorite bands? list 'um

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?
yes. no.

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