Full Name
*
Email
*
Phone
*
(###)
###
####
Preferred contact method
Communication Preferences
*
Please select what this contact should receive (select multiple)
Full Name
Email
Phone
(###)
###
####
Preferred contact method
Communication Preferences
Please select what this contact should receive (select multiple)
Please select your preferred payment method
*
Full Name
*
Preferred Name or Nicknames
Date of Birth
*
MM
DD
YYYY
Location
Address
If in person
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Availability
*
Please share the days and times that generally work best for weekly sessions at this location (e.g., Mondays 4–6 pm, Wednesdays mornings).
Is this the preferred location?
Yes
No
No preference
Secondary Location (optional)
If you are open to conducting sessions in a different location (for increased scheduling flexibility) please indicate here
Address
If in person
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Availability
Please share the days and times that generally work best for weekly sessions at this location (e.g., Mondays 4–6 pm, Wednesdays mornings).
Is this the preferred location?
Yes
No
No preference
Additional information
*
Please list any additional information I should know about accessing the location:
i.e, security, parking...
If session will be conducted at school or facility: any applicable contact information and procedures
Please write N/A if none are applicable
Instrument (s)
What instrument or instruments would you like to learn? If you're not sure yet, that's ok too!
Interests and Preferences
What kind of music do you enjoy most? Are there any specific styles or skills you'd like to learn musically?
Main goals/purpose for seeking music lessons
I.e., to gain confidence, to learn new skills, to prepare for an audition, for fun, etc.
Is there anything else you'd like me to know?
