Trial Violin Lesson Request Form

Trial Violin Lesson Request Form

Schedule your trial lesson with Dr. Lauren Pokorzynski!
Please fill out this form to schedule your trial violin lesson with Dr. Lauren Pokorzynski. She is a violinist with the Arkansas Symphony and a certified Suzuki teacher with over a decade of experience.
Student Full Name

First NameLast Name
Student Birthdate

MonthDayYear
Date
Guardian Full Name

First NameLast Name
Guardian Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
Guardian Email Address
example@example.com
Dr. Pokorzynski is available on *Thursdays from 1-3pm and from 4:30-6:30pm.* She teaches in Riverdale. Lessons are generally 30 minutes long. What date and time work best for you?
Any other specific date and time, if the above selection is not suitable. Remember, Thursdays 1-3 and 4:30-6:30.

MonthDayYear
Date
Hour MinutesAM/PM Option
YesNo
If yes, please describe:
YesNo
If yes, please describe the music instruction:
Why does the student want to learn violin? What style of music would they like to play? Are there any specific songs they would like to learn?
Should be Empty: