Lesson Request Form

Parent/Guardians Name

Phone Number

Address or Nearest Intersection:

Teachers are selected based on their proximity to your location. Providing an address or nearest intersection helps us pair you with a teacher.

Student 1 Name:

Student 1 Age:

Instrument Interested In:

Experience: e.g. Beginner

Student 2 Name:

Student 2 Age:

Instrument Interested In:

Experience: e.g. Beginner

Student 3 Name:

Student 3 Age:

Instrument Interested In:

Experience: e.g. Beginner

What are the days and times you have available for lessons?

Length of Lesson? 30 minutes, 45 minutes or 60 minutes

Do you have your own instrument at home?

Other:

Thank-you for filling out our lesson request form. Please allow one business day to receive a follow-up email confirming your information.

By submitting this form, you are giving us permission to contact you.