$25.00 – $65.00

Summer Session
$25 up to two instruments
$10 each additional instrument

Number of Instruments

Student Name*

Age*

Preferred Pronouns

School Grade*

Address*

City/State/Zip*

Parent/Guardian Name (students 18 and under)*

Email Address*

Primary Contact Name

Primary Contact Email Address

Primary Contact Phone Number

Emergency Contact and Number (other than the above)*

Does student have any special needs or medical conditions that we should be aware of? Please include allergies learning disabilities physical limitations etc.

How did you hear about Rockit Academy?

Additional Student Information:

Primary Instrument or Vocals Studying*

Other instrument(s) Auditioning

How Long?*

Vocalists can you harmonize?

Name of instructor or music school currently studying

Have you performed live with a band?

If yes with which band or music school?

Preferred style of music

Favorite Bands/Artists

Scholarship Information

CHECK HERE IF APPLYING FOR SCHOLARSHIP: Fill out a separate scholarship application and return with this form.

Click Here to fill out your scholarship form now.

Scheduling

This section ONLY applies to those students who may require special rehearsal scheduling due to: extensive travel time, religious commitments, or daily school dismissal. We suggest leaving an open schedule so that we may place students in a band best suited for them.

Please list specific dates you will not be available for rehearsals.

Please check specific vacation dates, performance conflicts, doctors appointments, etc. that will prevent you from attending rehearsals.

I understand that missing multiple band rehearsals may result in loss of a song and/or scholarship. This requirement is to ensure that each student enrolled in the program has a positive learning and educational experience with a full band.

Signatures

I hereby agree/give permission for my child to participate in the Rockit Academy Sessions at Brookdale Community College. I also give my permission to the Rockit Live Foundation and Brookdale Community College to use in publicity of any kind photographs, audio or video in which I/my child appear. The staff has my permission to seek emergency medical attention in the event of an emergency if my/my child's emergency contact cannot be reached. I agree that there are no refunds after the start of sessions."

Student Signature (18 and over)*

Parental/Guardian Signature for students under 18*