Summer Lesson Request Form
Student Name
*
First Name
Last Name
Parent/Caregiver Name (if applicable)
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Instrument
*
Please Select
Piano
Voice
Music Inclusion Program
Blind/Visually Impaired Program
Acoustic/Electric Guitar
Classical Guitar
Electric Bass Guitar
Ukulele
Bassoon
Clarinet
Flute
Oboe
Recorder
Saxophone
Euphonium
French Horn
Trumpet
Trombone
Tuba
Cello
Upright Bass
Violin
Viola
Percussion
Please select the instrument you, or your child, is interested in.
Teacher's Name
*
First Name
Last Name
Summer Lesson Length:
*
30 Minutes
45 Minutes
60 Minutes
Summer Lesson Packages
*
1 Lesson
2 Lessons
3 Lessons
4 Lessons
5 Lessons
6 Lessons
7 Lessons
8 Lessons
9 Lessons
10 Lessons
When would you like the lessons to begin?
*
Begin Extended Spring Lessons May/June 2025
Begin Summer Lessons July 2025
Begin Summer Lessons August 2025
Tuition Payment
*
Credit card - Please charge my card on file
Credit card - Please call me for updated card information
Teacher Confirmation
*
I have discussed this lesson package with the instructor and understand how the lessons will be taught (in-person, remote, hybrid)
Second Instrument
Yes, send me more information about trying a second instrument or voice.
Not at this time, but sounds super fun!
Submit
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