NVMA Student Information Please enable JavaScript in your browser to complete this form.Guardian Information LayoutFirst Name *Last Name *Email *LayoutMobile Phone *Home PhoneWork PhoneSMS and Email Consent *I AgreeBy providing your phone number and email, you consent to receive text messages and emails from Nevada Music Academy regarding your account, appointments, class updates, and events. Standard messaging rates may apply. You may opt out of text messages at any time by replying "STOP" and unsubscribe from emails by clicking the "unsubscribe" link in our communications. For more details on how we handle your personal information, please review our Privacy Policy.Student Information Layout StudentStudent First Name *Student Last Name *Student Gender *Choose SelectionMaleFemaleStudent Age *LayoutInstrument to Study *Experience LevelChoose SelectionBeginnerIntermediateAdvancedExpertAddress Information Address Line 1 *Address Line 2City *State *Zip Code *Emergency Contact Layout Emergency ContactEmergency First Name *Emergency Last Name *Relationship *Phone *How did you hear about us? (Choose One) *Google SearchGoogle AdsYelpFacebookGrouponYahooFoursquareYouTubeTwitterPinterestInstagramLinkedInRecital InvitationFlyerSchoolChurchDrive-By/Walk-inLayoutOther: (Please List)Referral: (Name of referral)Photo/Video/Other Media Permission Release: I acknowledge that NVMA occasionally uses student photo and video media for advertisement, publications, brochures, catalogs and programs. I acknowledge that such media may be used and that no claim is to be made against NVMA for its use. Initials *Submit
