Music Lesson Request Form

Music Lesson Request Form

We can't wait to get you started on your musical journey!
Student/Parent Info
Student Name*

First NameMiddle NameLast Name
Student Date of Birth

MonthDayYear
Date
Parent Name (If student is under 18)

First NameMiddle NameLast Name
E-mail*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Home Number

Area CodePhone Number
Cell Phone

Area CodePhone Number
Work Phone

Area CodePhone Number
Instrument Info
I would like to take lesson for
Current Experience

BeginnerIntermediateExpert
If not a beginner, how many years of experience do you have playing?
Additional Info
Preferred Instructor
Best day of the week for you to take lessons

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
Length of lesson interested in

Half HourFull Hour
Language

EnglishSpanish (Espanol)
Preferred learning platform

VirtualIn-Person at Bill's MusicOther
Best time of day for you to take lessons
Tell us about yourself!
Once you have filled out the application completely, please click the button below to submit your Lessons Request to Bill's Music.
Should be Empty:

Student/Parent Info