Full Name of Student:*

Student’s Age:*

Student’s Gender:*

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Type of Lessons:*

In-Home

At a Studio

Lessons of Interest:*

Guitar

Piano

Violin

Singing

Drums

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If other, please specify:

Student’s Level:*

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Has the student studied music before?*

Yes

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If yes, how long?

Full Name of Parent (if student is under 18):

Street Address:*

City:*

Postal Code:*

Cell Phone #:*

Email Address:*

Student Availability:*

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Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Available Times:*

How did you hear about us? *

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Blues Guitar Lessons

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Music Lesson Registration

Full Name of Student:*

Student’s Age:*

Student’s Gender:*

Type of Lessons:*

Lessons of Interest:*

If other, please specify:

Student’s Level:*

Has the student studied music before?*

If yes, how long?

Full Name of Parent (if student is under 18):

Street Address:*

City:*

Postal Code:*

Cell Phone #:*

Email Address:*

Student Availability:*

Available Times:*

How did you hear about us? *

I Agree*