Adult Registration Form

This form is for adults taking weekly private lessons, and anyone enrolled in a Mini-Session. When you complete and submit this form you are agreeing to follow the Studio Policies published on this website.

Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Preferred Phone Number for Messages About Lessons*
Is this a number that receives text messages?*
- Yes
- No
Alternate Phone Number if You Cannot Be Reached*
Preferred Email Address*
Lesson Program*
How will you be paying?*
Please describe your instrument in detail: acoustic vs. digital, make, model, condition, etc.*
What style(s) of music are you most interested in, and what are your musical goals, dreams or aspirations?*
May I show you (unidentified) in a photo or video on my website or Facebook page?*
- Yes
- No
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