New Student Form
For Music Lessons With Leah
Name
First Name
Last Name
Second Student Name (if applicable for the same family)
First Name
Last Name
Parent Name (If Applicable)
First Name
Last Name
Parent #2 Name (If Applicable)
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent #1 Phone Number
Please enter a valid phone number.
Parent #2 Phone Number
Please enter a valid phone number.
What kind of music lessons are you interested in?
Piano
Guitar
Voice
Audition Preparation
Music Theory/Music Fundamentals
Worship Coaching
Select your preferred payment methods
Cash
Check
Apple Pay
How would you like to have lessons?
In-Person
Online (FaceTime or Zoom)
How did you find me?
Please Select
Website
Nextdoor
Referral
School
If you found me from a referral, please type the name of the person who referred you.
Submit
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