Contact Inquiry Form

Contact Inquiry/Free Trial Session Form
Please fill out the following information. We will contact you with more information, set up a Free 15min Trial Session, and/or help you with registration. Thanks for contacting us!
How Did you hear about us? (Choose all that apply)

Passed by Word of Mouth Internet Search
Student's Name *

First Name Last Name
Birth Date *

Month Day Year
Instrument Choice(s). Choose all that apply. *

Piano Voice Guitar Ukulele Violin Viola Flute (online only at the moment) Clarinet (online only at the moment) Saxophone (online only at the moment) Trumpet (online only at the moment)
Experience Level (e.g. "Beginner" or "Playing for 4 years - last piece I worked on was ...") *
Parent/Guardian Name (or "Self") *

Prefix First Name Last Name
Preferred contact number *

Area Code Phone Number
E-mail *
We offer a Free 15-minute Trial Session to prospective students. We generally try to schedule it for a day/time that would become your actual lesson spot should you choose to enroll. Would you like to register for a free trial? *

Yes (Please answer the next 2 questions regarding scheduling preferences) No, I would prefer to just register/enroll (We will contact you with a registration form) Not sure yet, I'd like more information first
If you answered "YES" to the Free 15-minute Trial Session, please answer the following 2 questions regarding scheduling preferenes:
1. What days and blocks of time are you available for lessons? Remember, your trial session time will likely turn into your actual lesson time should you enroll. Please indicate BLOCKS of availability, e.g. "Mondays, 3-6pm" or "Thursdays, ANY"
2. What days and/or times are CONFLICTS that must be avoided? Please be as detailed as possible. If no conflicts, write "none".
Do you have any questions? Is there anything you'd like us to know that will help us meet your music needs?
Studio Policy: For information regarding our studio policies, go here: https://www.bergenacademy.com/policies
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Contact Inquiry/Free Trial Session Form