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Lessons Registration Form

Thank you for registering for private lessons! Please complete the online registration form on this page, and we will get back to you as soon as possible (usually within 2 business days).

This is a free, preliminary, “no obligation” registration. You are not making a firm commitment to take lessons with us until completing full registration paperwork in person and making your initial payment for lessons.

(If you have difficulty with this form, you may also download a PDF version which you can print out, fill in by hand, and then fax or mail in to us.)

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

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:

Select the preferred instructor:

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

Student Availability

Note about scheduling - The more options you can provide for your availability, the easier it will be to match you with a teacher. Please provide a minimum of 2 days with a 2-3 hour window on each day.

Indicate a preferred lesson length (Some ages, instruments, and teachers have a 45-Minute minimum):
 60 Minute 45 Minute 30 Minute

Indicate which days the student can have a lesson (must choose at least one)
 Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Please fill in a time range for each day the student is available for a lesson (i.e. start at 3pm - end by 7pm)

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

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 indicate any special offer you are responding to:

Please let us know how you heard about us:

You may also review available lesson slots and book a tentative first lesson online at Schedulicity.com. New students should also schedule an Orientation and Registration appointment with the Academy Director (completely FREE) for BEFORE any lesson they may schedule online.

PLEASE NOTE: Any first lesson you may book online may not be a regular opening in a teacher’s schedule, so this lesson is not reserved or confirmed until your in-person Orientation and Registration session.

Schedule online now
May 21st, 2009 | Category: forms | Comments are closed

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