New Student Registration

Student Name:

Instructor Name:

Age: Birthdate:

Parent/Guardian Name:

Home Phone:

Work Phone:

eMail:



Mailing Address:

,


Home Address: (if different from mailing address)

,




Instrument:

Desired Lesson Day:


Desired Lesson Time:


Has the student previously taken private music lessons?  No Yes
If so, for how long?

Does the student play in any school or community groups?  No Yes
If so, which ones:

Does the student play any other instruments?  No Yes
If so, which ones:

Please read our Lesson Policy before submitting this form.

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