My name is: *

First Name

Last Name

My birth date is:

MM

DD

YYYY

Prior Lessons? *

Yes

No

Accelerated & Advanced Options (Potential Interests)

Twice-weekly lessons

Double-hour lessons

Three or more lessons per week

More than one instrument

Coaching for exams, auditions, performances, competitions

Music theory, composition, and/or songwriting

Practice Plan & Expectations *

Prefer Little to No Practice Requirements

Regular Light Practice Routine/Schedule

Regular Full Practice Routine/Schedule

Not sure yet, would like to discuss

Availability for Introductory Lesson *

Introductory lessons are 30 minutes and cost $45.00 (in-studio) or $65 (in-home). These lessons provide student learning and also help us learn about the student to help determine the best learning environment and pacing for them. Please select as many range options as possible.

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Morning(s)

As early as possible

Mid-day

Afternoon(s)

Evening(s)

As late as possible

Phone *

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country