Epitelo Music Academy

Teaching music to every child

Ensemble Registration

Please view the Ensemble Programs page to learn more about our new offerings if you have not done so. Then, if you are interested in signing up, please fill out the form below!

Parents -- please fill out separate forms for each of your children, if you are registering more than one.
BasicsStudent Name: Current Student?
Yes  No
*If yes, please skip to either "Small Ensemble" or "Large Ensemble" forms for musical details.
Birthday: Parents' Names: Phone number: Cell phone: Address: Email: If no, are you interested in private lessons?
Yes  No  Maybe
Does the student have autism?
Yes  No
If yes, please describe any relevant information or limitations: Large Ensemble
What instrument do you play? How many years have you been playing? For how many years have you taken private lessons? What level do you consider yourself? If you are not a current student, please describe your level of playing, experience, type of music you play, etc.
Does the student have any special needs or requirements? If yes, please describe:
Small Ensemble
What instrument do you play? How many years have you been playing? What level do you consider yourself? If you are not a current student, please describe your level of playing, experience, type of music you play, etc.
What type of ensemble would you like (violin duet, clarinet trio, string quartet, etc.)? If you are signing up with other students, please list their names. What day(s) are you available for coaching?
Monday
Tuesday
Thursday
Friday
Saturday
What time of day?
Morning
Afternoon
Evening
Other relevant information (disability, etc.)
Parents: This information is complete and correct, to the best of my abilities.
Yes  No

Epitelo Music Academy. 4620 Dolomite Ct., Columbus OH 43230. (614) 625-1064. Kate@epitelomusic.com.