Music Lesson Registration
Name
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First Name
Last Name
Email
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example@example.com
Phone Number
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Please enter a valid phone number.
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Enrollment Term
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Please Select
Semester One- Jan 9, 16, 23, 30, Feb 6, 13, 20, 27, March 5
Semester Two - April 30, May 7, 14, 21, 28, June 4, 11, 18, 29 ROMP
Semester Three- Aug 6, 13, 20, 27, Sep 3, 10, 17, 24, Oct 1
Semester Four - Oct 22, 29, Nov 5, 12, 19, 26, Dec 3, 10, 17
Total Number of Classes/Students
*
Please Select
1
2
3
4
5
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Student #1
*
First Name
Last Name
Parent/Guardian Name (if student is under 18)
First Name
Last Name
Age (Student #1)
*
Class (Student #1)
*
Please Select
5pm - Bluegrass Basic for Kids ages 6, 7, 8.
5pm Beginner - Fiddle
5pm Beginner - Guitar
5pm Beginner - Mandolin
5pm Beginner - Banjo (ages 12 and up)
6pm Beginner Plus - Fiddle
6pm Beginner Plus - Guitar
6pm Beginner Plus - Mandolin
6pm Beginner Plus - Banjo
7pm Intermediate - Fiddle
7pm Intermediate - Guitar
7pm - Band
Do you ALREADY have an instrument on loan? (Student #1)
*
Please Select
YES
NO
Do you need an instrument?
*
Please Select
I have my own!
Yes
No
Instrument Loan
Please Select
Ages 9-11 Fiddle
Ages 9-11 Guitar
Ages 12 & Up Fiddle
Ages 12 & Up Guitar
Mandolin (One Size)
Banjo (One Size)
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Student #2
First Name
Last Name
Parent/Guardian Name (if student is under 18)
First Name
Last Name
Age (Student #2)
Class (Student #2)
Please Select
5pm - Bluegrass Basic for Kids ages 6, 7, 8.
5pm Beginner - Fiddle
5pm Beginner - Guitar
5pm Beginner - Mandolin
5pm Beginner - Banjo (ages 12 and up)
6pm Beginner Plus - Fiddle
6pm Beginner Plus - Guitar
6pm Beginner Plus - Mandolin
6pm Beginner Plus - Banjo
7pm Intermediate - Fiddle
7pm Intermediate - Guitar
7pm - Band
Do you ALREADY have an instrument on loan? (Student #2)
Please Select
YES
NO
Do you need an instrument?
Please Select
I have my own!
Yes
No
Instrument Loan
Please Select
Ages 9-11 Fiddle
Ages 9-11 Guitar
Ages 12 & Up Fiddle
Ages 12 & Up Guitar
Mandolin (One Size)
Banjo (One Size)
Student #3
First Name
Last Name
Parent/Guardian Name (if student is under 18)
First Name
Last Name
Age (Student #3)
Class (Student #3)
Please Select
5pm - Bluegrass Basic for Kids ages 6, 7, 8.
5pm Beginner - Fiddle
5pm Beginner - Guitar
5pm Beginner - Mandolin
5pm Beginner - Banjo (ages 12 and up)
6pm Beginner Plus - Fiddle
6pm Beginner Plus - Guitar
6pm Beginner Plus - Mandolin
6pm Beginner Plus - Banjo
7pm Intermediate - Fiddle
7pm Intermediate - Guitar
7pm - Band
Do you ALREADY have an instrument on loan? (Student #3)
Please Select
YES
NO
Do you need an instrument?
Please Select
I have my own!
Yes
No
Instrument Loan
Please Select
Ages 9-11 Fiddle
Ages 9-11 Guitar
Ages 12 & Up Fiddle
Ages 12 & Up Guitar
Mandolin (One Size)
Banjo (One Size)
Student #4
First Name
Last Name
Parent/Guardian Name (if student is under 18)
First Name
Last Name
Age (Student #4)
Class (Student #4)
Please Select
5pm - Bluegrass Basic for Kids ages 6, 7, 8.
5pm Beginner - Fiddle
5pm Beginner - Guitar
5pm Beginner - Mandolin
5pm Beginner - Banjo (ages 12 and up)
6pm Beginner Plus - Fiddle
6pm Beginner Plus - Guitar
6pm Beginner Plus - Mandolin
6pm Beginner Plus - Banjo
7pm Intermediate - Fiddle
7pm Intermediate - Guitar
7pm - Band
Do you ALREADY have an instrument on loan? (Student #3)
Please Select
YES
NO
Do you need an instrument?
Please Select
I have my own!
Yes
No
Instrument Loan
Please Select
Ages 9-11 Fiddle
Ages 9-11 Guitar
Ages 12 & Up Fiddle
Ages 12 & Up Guitar
Mandolin (One Size)
Banjo (One Size)
Student #5
First Name
Last Name
Parent/Guardian Name (if student is under 18)
First Name
Last Name
Age (Student #5)
Class (Student #5)
Please Select
5pm - Bluegrass Basic for Kids ages 6, 7, 8.
5pm Beginner - Fiddle
5pm Beginner - Guitar
5pm Beginner - Mandolin
5pm Beginner - Banjo (ages 12 and up)
6pm Beginner Plus - Fiddle
6pm Beginner Plus - Guitar
6pm Beginner Plus - Mandolin
6pm Beginner Plus - Banjo
7pm Intermediate - Fiddle
7pm Intermediate - Guitar
7pm - Band
Do you ALREADY have an instrument on loan? (Student #3)
Please Select
YES
NO
Instrument Loan
Please Select
Ages 9-11 Fiddle
Ages 9-11 Guitar
Ages 12 & Up Fiddle
Ages 12 & Up Guitar
Mandolin (One Size)
Banjo (One Size)
Do you need an instrument?
Please Select
I have my own!
Yes
No
Please list the shirt size for all students registered.
*
Subtotal
Total Amount Due
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