Music Lesson Registration

Student Name*

First NameLast Name
Parent Name (If applicable)

First NameLast Name
Email of Parent/Adult Student*
example@example.com
Secondary Email
example@example.com
Phone Number*
Please enter a valid phone number.
Secondary Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Pronouns
Birthday*

MonthDayYear
Date
Instrument*

GuitarBassDrumsPianoVoiceViolinFluteUkulele
Skill Level
Preferred Teacher
Do you prefer In-Person or Online Lessons?

In-PersonOnlineNo Preference
Skype Username (For Online Lessons)
FaceTime ID (For Online Lessons)
Preferred Date and Time*
How did you hear about us? *
Please tell us the name of the person who referred you so they can take advantage of our referral program!
Please describe how you heard about us!
Would you like to enrol a second student?*

YesNo
Enrol A Second Student

Each student under the same family only pays half the admin fee - $15.00 a year.
Student Name*

First NameLast Name
Pronouns
Birthday*

MonthDayYear
Date
Instrument*

GuitarBassDrumsPianoVoiceViolinFlute
Skill Level
Preferred Teacher
Do you prefer In-Person or Online Lessons?

In-PersonOnlineNo Preference
Preferred Date and Time*
Name

First NameLast Name
Should be Empty:

Enrol A Second Student