Student Information

Student Name (required)

Student Date of Birth (required)

Parent Name (if student < 18 years old)

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

Street Address (required)

City (required)

State (required)

Zip Code (required)

Phone Number 1 (required)

Phone Number 1 (required) is:
 Home Cell Work

Phone Number 2

Phone Number 2 is:
 Home Cell Work

Phone Number 3

Phone Number 3 is:
 Home Cell Work

Class Selection and Previous Experience

Select the class you wish to attend:
Beginning GuitarBrazilian Guitar CourseIntro to Music TheoryListening to Music Lecture and DiscussionKeyboard Ensemble WorkshopItalian Opera MasterclassOther

Is the student a beginner?  Yes No

If no, then please briefly describe previous experience:

Student Availability

For classes that don\'t already have a specific posted schedule, please indicate your availability. The more options you can provide for your availability, the easier it will be to schedule you in a session. Please provide a minimum of 2 days with a 2-3 hour window on each day.

Please indicate which days the student can attend a group class
 Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Please fill in a time range for each day the student is available for a class (i.e. 3pm - 7pm)

Sunday Times:
Monday Times:
Tuesday Times:
Wednesday Times:
Thursday Times:
Friday Times:
Saturday Times:

Other Student Information

Does the student have any special needs?
 Yes No

If so, please describe:

Please let us know how you heard about us: