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Lessons Registration

By BigBlueOp, on July 13th, 2011

Thank you for your interest in lessons! Filling out this registration form will give us the information we need to help you get started.

(Your information is not sold or distributed to anyone…!)

Student Information

Student Name (required)

Student Birth Month/Year

Parent Name (if student < 18 years old)

Student's (or Parent's) Email (required)

Phone Number 1 (required)

Phone Number 1 (required) is:
 Home Cell Work

Phone Number 2

Phone Number 2 is:
 Home Cell Work

Instrument Information and Previous Experience

Select the instrument to be studied:

Is the student a beginner?  Yes No

If no, then please briefly describe previous experience:

Please select the student's level of interest and commitment to practice:

Which tuition schedule are you interested in following?
 Quarterly (12 lessons, best discount) Monthly (4 lessons, good discount) Individually (pay-per lesson, no discounts)

Student Availability

Note about scheduling - The more options the student is available, the better the chance of matching a teacher's schedule.

Indicate a preferred lesson length (For some ages and instruments, there is a 45-Minute minimum):
 60 Minute 45 Minute 30 Minute

Indicate all the days and times during which the student can have a lesson:

Sundays:  Mornings (9am-Noon) Afternoons (Noon-5pm) Evenings (5pm-10pm)
Mondays:  Mornings (9am-Noon) Afternoons (Noon-5pm) Evenings (5pm-10pm)
Tuesdays:  Mornings (9am-Noon) Afternoons (Noon-5pm) Evenings (5pm-10pm)
Wednesdays:  Mornings (9am-Noon) Afternoons (Noon-5pm) Evenings (5pm-10pm)
Thursdays:  Mornings (9am-Noon) Afternoons (Noon-5pm) Evenings (5pm-10pm)
Fridays:  Mornings (9am-Noon) Afternoons (Noon-5pm) Evenings (5pm-10pm)
Saturdays:  Mornings (9am-Noon) Afternoons (Noon-5pm) Evenings (5pm-10pm)

Please indicate any other activities the student is engaged in which may have an impact on scheduling and practice time between lessons:

Other Student Information

Does the student have any special needs?
 Yes No

If so, please describe:

Please indicate any specific goals or motivation for wanting music lessons:

Please let us know how you heard about us:

All done? Then click SEND below! Thanks for registering, and we will get back to you very soon!

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