Student Intake Form
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
City/Location?
Which instrument(s) would you like to take lessons for?
Drum set
Piano
Guitar
Bass
Other
What is your experience level?
Just Starting Out
Beginner (less than 3 months)
Beginner-Intermediate (3 - 6 months )
Intermediate (6-12 months)
Intermediate-Advanced (a year or longer of continuous play)
Advanced (2 years or longer)
Other
What type of music do you play and/or are interested in?
What are you interested in learning more about, musically speaking?
What are your preferred days and times for a lesson?
Online or In person?
In person
Online
Either is fine
Anything you’d like us to know?
Soonest Date/Time you’d like to start?
Submit
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