Contact for Music Lessons

Student Name

First

Last

Parent Name

First

Last

if you are an adult student just write your name twice

Email

Phone Number

Student Birthday

Preferred Instruction

Preferred Lesson Duration

What day/times are you NOT available for lessons?

Please be specific! Let me know the days/times you are NOT available for lessons.

Preferred Lesson Days/Times

Let me know your optimal lesson days/times. I can’t guarantee that I can meet these, but they help me understand your preferences.

Have you taken music lessons before?

yes
no

Previous Musical Experience

Tell me about your journey so far with music. Have you started yet? How long have you been playing for? What have you studied & learned so far?

Do you have any specific goals for the lessons?

Are you interested in performing? Playing in a band eventually? Writing music? Or are you more casual, wanting to learn to play for yourself not so keen on performing?

Is there anything else you'd like to add?

Agreement to Terms & Conditions

I acknowledge and agree to abide by the terms and conditions set forth by the instructor.