Online Application

Jean Mazzei

Andrea Fultz



		Free Report

Acoustic Guitar Electric Guitar Voice Piano/Keys Bass Drums Sax/Clarinet Mandolin/Fiddle

Please complete and submit this information. *Indicates required fields.

Click here for the Little Bears Online Application

Contact Information

First Name*:

Last Name*:

Address*:

City*:

State*:

Zip*:

Email Address*:

Home Telephone:

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Mobile Telephone:

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Work Telephone:

( ) - xt:

Best time to call:

Best Number to call:

Home | Work | Mobile

Workplace:

Job Title:

If you are under 21...

Student year of birth:

Age:

Parent's Name/ Bill to:

Caretaker's Name
(for Little Bears Program only):

About You

Check all the places you've heard about Blue Bear*:

Doorhanger	In-store Catalog	Yellow Pages
Google	Craigslist	Word of Mouth
Bay Guardian	Direct Mail	Marina Times/New Fillmore
Yahoo	SF Chronicle	Other

Check one (optional):

Check one (optional):

Male
Female
Transgender
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What hours can you NOT be at Blue Bear?:

What programs are you interested in?:

Instrument (or Voice):

Years Played: Level:

Instrument:

Years Played: Level:

Do you read written music?

No | A Little | Fairly Well | Well

Previous music education or lessons, performaing experience, if any:

What musical styles or artists have influenced your music or do you most enjoy?

What style of music would you like to pursue in your studies?

Are there any special goals or ambitions you hope to attain?

Any further comments or special needs?

Interview Options

Check one*:

Please call me to set up a new student interview.
I have already set up a new student interview.
Please have the Program Director call me for my new student interview.

We give enrollment priority to those who come to Blue Bear in person for a new student interview or who pre-schedule a phone interview - check the first box above. If you still prefer to have us call you for your interview, our Program Director will contact you within the next week.

By submitting this application I certify that I have read and agree to abide by Blue Bear's policies. I understand that for private lessons there is a two-day cancellation policy. If I notify the Blue Bear desk staff in a timely manner I will be charged a $10 administrative fee for the cancellation. I will be charged in full for any lesson not cancelled in a timely manner. I understand that for group classes I must notify Blue Bear two days before the second class meeting in order to qualify for any partial refund of fees. I understand that the annual Membership Fee and group class deposits are not refundable and not transferable.

Yes, I agree to these terms.(*required)

Blue Bear School of Music does not discriminate according to race, color, or national or ethnic origin in the administration of its educational and admissions policies and in its programs.