Intake Form
Fill out this brief form to schedule your Private Music Lesson!
Student Name
*
First Name
Last Name
Student Age
*
Guardian Name (N/A if student is over 18 years old)
First Name
Last Name
Best Contact Phone Number
*
Please enter a valid phone number.
Best Contact Email
*
example@example.com
What lessons are you interested in taking?
*
Voice (w/ Kayla)
Piano (w/ Kayla or Kurt)
Guitar (w/ Kurt)
Ukulele (w/ Kayla or Kurt)
Bass (both Bass Guitar and Upright offered) (w/ Kurt)
Violin (w/ Kayla or Kurt)
Clarinet (w/ Kurt)
Music Theory (w/ Kayla or Kurt)
Songwriting (w/ Kayla)
Beatboxing (w/ Kurt)
Trumpet (w/ Kurt)
Other
Duration of Lesson
*
30 minutes
45 minutes
60 minutes
Location: Where are you looking to take lessons?
*
Student's Home
Teacher's Studio (Located in Stamford, CT)
Online
If you chose "Student's Home", please provide your ZipCode.
Type of Lesson
Private Lesson (One-on-one)
Semi-Private Lesson (Small group 2-3 students. Parent/Child, Siblings, Couples)
Virtual Lesson (via Zoom)
Which Payment Plan would you like to select? (Visit kx2music.com/lesson-packages for more info)
*
Monthly (minimum 4 lessons)
Semester (minimum 10 lessons)
Trial / Individual Lesson (One Time Payment)
Please select which days and times you are available for lessons. *Afternoon indicates 2:00pm-5:00pm, Evening 5:00pm-8:00pm.
*
Monday Afternoon
Monday Evening
Tuesday Afternoon
Tuesday Evening
Wednesday Afternoon
Wednesday Evening
Thursday Afternoon
Thursday Evening
Friday Afternoon
Other
Is there anything else you'd like us to know? (optional)
Agreement
PAYMENT: Due before or at time of service. We accept Zelle, Cash, Check, Venmo (2% Tax) or Credit/Debit (3% Tax). CANCELLATION POLICY: Please understand that when you forget or cancel your appointment without giving enough notice, we miss the opportunity to fill that appointment time, and clients on our waiting list miss the opportunity to receive services. We do understand that in some instances, cancellations are unavoidable. If you find yourself unable to keep an appointment, as a courtesy to our team and guests, we request at least a 24 hour advance notice. You will be charged if you cancel under a 24 hour notice unless due to emergencies. PROPERTY: The Student/Guardian will be responsible for any damage incurred by the student to any property owned by Kx2 Music. CONSENT: The Parent/Guardian gives permission for Kx2 Music to teach the student under 18 years of age at agreed location (Student Home, Teacher Studio, or Online), even if Parent/Guardian chooses not to be present for the lesson.
Please Check Box to Proceed.
*
I understand & agree to the terms above.
Thank you! We look forward to meeting you!
We will contact you shortly.
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