Student Registration | Sharla Bender Studios

Registration Received

Your registration is under review. Dr. Bender will reach out to you shortly.

Contact Information

Parent / Guardian First Name

Parent / Guardian Last Name

Email Address *

Phone Number *

2nd Phone Number — optional

Street Address

City

State

Zip Code

Students

Additional Information

Preferred Method of Communication

Email Text

Preferred Billing Cycle

Monthly Quarterly Semester

At-Home Practice Instrument(s)

Consent to use student images for Studio Website and Social Media Posts

Yes — I consent to photos/
videos being shared No — please do not share
photos/videos

Instagram Username

LinkedIn Username

How did you hear about us?

Additional Notes

Affirmation Statement

Please download, print, and sign the Affirmation Statement for each student enrolling.
Bring the signed form to your first lesson.