We will contact you to schedule your trial lesson shortly after we receive your information. Please disregard any day/time listed on this page! Again, we will be in touch soon to schedule. Thank you!
Start Date/Time: End Date/Time:
Fee per Student: Room:
* - denotes required fields
Family Information
First Name:* Last Name: *
Home Phone: Cell #: Work #:
Email:* (Emails are kept confidential)
Address: *
City: * State: * Zip: *
Emergency Contact Info (please include two, with phone numbers)
Students entered below will be added to your family's account
For which instrument(s) would you like to set up a trial lesson?*
Is there a certain teacher with whom you'd like the trial lesson? If yes, which teacher please?
Additional Information:
Other Questions/Comments:
Credit Card Verification:
Card Number: *  
Name as it appears on card: *
Card Expiration Month: *   Exp Year: *
Address Line 1: Address Line 2:
City: State: Zip:*