2025-2026 Private Music Lesson Request

2025 - 2026 PRIVATE LESSON REQUEST
2025-2026 Private Lesson Request Form
We will be in contact with you shorly to arrange a lesson slot based on the information provided in this form. Please note, we are not able to guarantee the availability of any slot requested on this form.
Parent / Guardian #1 Name*

First NameLast Name
Parent / Guardian #1 Email *

Confirmation Emailexample@example.com
Parent / Guardian #1 Cell Phone*
Was the student registered for 2024-2025 Private Lessons*

YesNo
Is student registered for 2025-2026 Youth Dance or Theater classes

YesNo
Student Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
How you hear about us?

FriendSocial MediaInternet searchOther
Date of Birth

MonthDayYear
Student Birth Date*

MonthDayYear
Gender Identity

FemaleMaleNon-Binary
Lesson Type (Select all that apply)*

VoicePianoDrumsGuitarViolin/CelloOther

Preferred Days *

Length of Lesson

30 minutes per week60 minutes per week
Please let us know if you have a preferred teacher:
Additional comments or information you would like us to know: ex. earliest arrival time
Should be Empty:

2025 - 2026 PRIVATE LESSON REQUEST