Music Lesson Interest Form
*This is NOT a sign-up for any classes
Parent Email Address
*
example@example.com
Parent Name
First Name
Last Name
Would you like to opt in for email updates about upcoming class information (including pricing and scheduling) when they become available?
*
yes please
no, thank you
How many students are you interested in enrolling?
*
Please select the age(s) for the student(s) you would like to enroll (select all that apply)
*
under 5
5-7
8-12
13-16
16+
Which instruments would your student be interested in learning?
*
Piano (intro to)
Piano
Acoustic Guitar (intro to)
Acoustic Guitar
Vocal Performance
Musical Theater
Which option listed below would work best for your family
Renting an instrument from a local music store.
Bringing their own instruments.
No need for any instrument.
Other
What lesson schedule would be ideal for your family
weekly
every other week
monthly
no preference
Will you be using a StepUp Scholarship?
Yes
No
If your child has already been enrolled in music lessons, please list the type of lesson(s), how long your child has been attending, and the reason for stopping (if applicable):
Please list any accommodations your child/family would need to set your student up for success:
Submit
Should be Empty: