Academy of Music, Art & Education LLC
Please return form to:
Academy of Music, Art & Education LLC
950 Corporate Parkway, Suite 100
Wentzville, MO 63385 Todays Date:______________
Email: jacque@academymae.com
Name:____________________________________________Birth Date:________________
Address:__________________________________________Phone:___________________
_________________________________________________ Zip:_____________________
Parents name(s)_____________________________________________________________
Email:_______________________________School:________________________________
Requested Class:____________________________________________________________
Educational need:___________________________________________________________
Date & time requested - 1st choice _____________________________________________
Date & time requested - 2nd choice _____________________________________________
Date & time requested - 3rd choice _____________________________________________
How did you hear about us? ___________________________________________________
Applications will be reviewed and interviews setup to match you with the best teacher for your child/self.
A $29.00 registration fee will be due upon registration.