Student Name * First Name Last Name Age * 4-6 years of age (Celebration of music only) 7-13 years of age 14-17 years of age Adult Parent/Guardian (If student is under 18) First Name Last Name Additional Parent/Guardian First Name Last Name Email * Phone Number * (###) ### #### Secondary Phone Number (###) ### #### Preferred form of Contact Phone Text Email What services are you interested in? Individual Lessons Semi-Private Lessons Celebration of Music ( 4-6 years of age ) Group Lessons (Subjected to Availability) Type of Lesson * Guitar Ukulele Bass Mandolin Music Theory Voice Rhythm Instruction Piano (Beginner level only) Sound Equipment Education Song Writing What is your(or their) level of playing on this instrument? Beginner Intermediate Advanced I'm not sure Perfered days of the week * My main teaching days for now are Wednesday and Thursday but will extend when there is more interest on other days Monday Tuesday Wednesday Thursday Friday Preferred times * My teaching times are generally 1 p.m.-8 p.m. but am available in the morning as well Morning (between 7a.m - 11a.m) Afternoon/Evenings (between 1p.m.-8p.m.) Notes Do you or your family member have any allergies? If Yes, we will talk about this in more detail during our first correspondence. Yes No Thank you, please allow up to 72 business hours for me to respond. If you are interested in taking lessons with me and are ready to take that next step, please fill out the form below. Thanks!
