Inquiry Form
Student Information
Branch:
Please Select
Rochester
Canandaigua
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First Name:
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Last Name:
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Address:
Address 2:
City:
State:
Zip:
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Phone:
Fax:
Cell:
*
Email Address:
Birthdate (MM/DD/YY):
Student Information (Ages 18 and under)
Student's School:
Grade:
School Phone:
Parent/Guardian Contact Information
Mother/Guardian Name 1:
Employer:
Position:
Work Phone:
Cell Phone:
Work Email Address:
Currently Unemployed:
Father/Guardian Name 2:
Employer:
Position:
Work Phone:
Cell Phone:
Work Email Address:
Currently Unemployed:
Adult Student Information
Employer:
Position:
Work Phone:
Work Email Address:
Currently Unemployed:
How did you hear about Hochstein School of Music & Dance?
(check all that apply)
Flyer/Brochure in Mail
Friend
Open House
Flyer/Brochure at community location
Internet/Email
Phone Book
Newspaper Article
Radio
My School or Teacher
Newspaper Ad
Television
Other
Area of Interest
(offerings may vary depending on your preferred branch)
Instrument
Please Select
Bassoon
Cello
Clarinet/Saxophone
Double Bass
Flute
Guitar
Harp
Horn
Organ
Percussion
Piano
Trombone/Tuba
Trumpet
Violin
Viola
Voice (ages 14+)
FUNdamentals of Music (ages 0-6)
Little Singers (ages 4-Grade 2)
Dance (ages 3-adult)
No Selection
Ballet
Modern
Tap
Ballroom
Flamenco
Other
Youth singers (grades 3-12)
Youth orchestras and Symphonies (grades 1-12)
Chamber Music
Suzuki Instruction
No Selection
Violin
Viola
Cello
Flute
Other
Unsure
After you submit this form, a Hochstein representative will contact you in the next few days.
Preferred form of contact:
Please Select
Phone
Email
Please mail me a catalog.
*
denotes required field