Student Information Form
Store Location:
*
St. Clairsville, OH
Zanesville, OH
Parkersburg, WV
Lancaster, OH
Parent/Guardian Name:
Please leave blank if you are an adult student.
Student Name:
*
Student Age:
*
Phone Number
*
Please enter a valid phone number.
Phone Number:
*
Email:
*
Would you like added to our email list?
Yes
No
Instrument Interest:
*
Please Select
Acoustic Guitar
Electric Guitar
Bass Guitar
Banjo
Mandolin
Ukulele
Harmonica
Piano
Voice
Drums
Flute
Clarinet
Saxophone
Trumpet
Trombone
Violin
Viola
Has the student ever taken lessons on selected instrument?
*
Yes
No
If yes, how long?
The student is
*
a beginning player
an intermediate player
an advanced player
Does the student own the instrument that they are interested in learning?
*
Yes
No
Availability
Time slots are dependent on teacher availability
Monday
10:00 am - 12:00 pm
12:30 pm - 4:00 pm
4:30 pm - 7:00 pm
Tuesday
10:00 am - 12:00 pm
12:30 pm - 4:00 pm
4:30 pm - 7:00 pm
Wednesday
10:00 am - 12:00 pm
12:30 pm - 4:00 pm
4:30 pm - 7:00 pm
Thursday
10:00 am - 12:00 pm
12:30 pm - 4:00 pm
4:30 pm - 7:00 pm
Friday
10:00 am - 12:00 pm
12:30 pm - 4:00 pm
4:30 pm - 5:00 pm
Saturday
10:00 am - 12:00 pm
12:30 pm - 3:00 pm
Teacher Preference (If known):
Additional Notes:
Submit
Should be Empty: