Free 45-Minute Lesson Intake Form

Free 45-Minute Lesson Intake Form

This is a one-time intro class taught by Jordan W. Carter with an option to continue. I’ll share personalized feedback and recommend next steps.

🥁 Section 2: Get to Know You
Who is this lesson for?*

Myself (Adult Learner)My Child (Ages 9-18)
Have you studied percussion or music before?*

Yes, currently taking lessonsYes, in the pastNo, I’m brand new!
What do you want to study?*

Snare DrumDrumset (not offered)Mallet Percussion (Xylophone, Bells, etc)
What are your goals with percussion/music? *
(e.g. Fun & creativity, stress relief, skill building, college prep, professional training, etc.)
How did you hear about Harlem Percussion Academy? *

🔒Section 4: Security References
I ask all new students (or their parents/guardians) to provide a reference or brief background—just to ensure safety and a good fit for the space. This could be a music teacher, school contact, or even a community member.
Name of Reference #1*

First NameLast Name
Phone Number of Reference #1*
Please enter a valid phone number.
Email of Reference #1
example@example.com
Name of Reference #2*

First NameLast Name
Phone Number of Reference #2*
Please enter a valid phone number.
Email of Reference #2
example@example.com

Deposit*

Free 45 Minute Lesson DepositFully refunded at the start of the lesson.

$50

Subtotal

$0.00

Tax

$0.00

Total

$0.00