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Open House Inquiry

Inquiry Form for Open House on Saturday, September 14th.

To be completed/filled out by Staff.

Open House 2024 Inquiry Form

Inquiry form managed by staff at Open House on September 14, 2024.

Student Name*
First Last
Student Date of Birth*
For adult students, you are welcome to enter 01/01/1920 if you prefer not to be specific about age.
MM slash DD slash YYYY
Grade In -or- Entering*
For adult student, enter "N/A"
Program of Interest*
- Music Together (Early Childhood: Birth to 5)
- Music Safari (K to 5th Grade)
- Private Lessons
- Youth Theatre with Music
Instrument of Interest, or Voice
Safari Class of Interest
- Piano Safari
- Ukulele Safari
- Hand Drumming Safari
- Songwriting Safari
Do you have a working instrument to use for daily practice?*
- Yes, I have an instrument at home.
- No, but I will purchase/rent prior to starting lessons.
- No, and I need assistance to obtain an instrument.
- N/A, I'm a voice student.
Pakachoag Teacher Name? (If known)
If you are requesting assignment to a specific teacher, please note teacher's name here.
Is the Student connected with...*
- African Community Education (ACE)
- Black Excellence Academy (BEA)
- Boys & Girls Club of Worcester
- CENTRO
- Chandler Magnet Elementary School
- Elm Park Elementary School
- Quinsigamond Elementary School
- None of the Above
Name of Student's Day School (for School-Aged Students)
If not listed above, please note the name of the student's elementary/middle/high school. Or indicate 'none' or 'homeschooled'.
Contact Information
Parent/Caregiver 1 -or- Adult Student Name*
First Last
Parent/Caregiver 1 -or- Adult Student Email*
Parent/Caregiver 1 -or- Adult Student PRIMARY Phone*
Send/Receive Texts?*
- Yes, the School may send texts to this number.
- No, I do not want to receive texts on this number.
Interested in Applying for Financial Aid?
- Yes
- No
How did you hear about the open house?*
- Word of Mouth: Friend/Family Referral
- Word of Mouth: School Teacher Referral
- Online: Social Media (Facebook, Instagram, Etc.)
- Online: Search Engine (Google, Bing, etc.)
- Print Media: Newspapers, Magazines, Etc.
- Print Media: Brochures, Postcards, Etc.
- Attended a Pakachoag Performance or Event
- Other

(508) 791-8159
Pakachoag Music School of Greater Worcester
10 Irving Street, Worcester, MA 01609
info@pakmusic.org

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