SM_reg_form

Please provide the following information:

Student Information:

Student Last Name

* Required

Student First Name

* Required

Grade (or 'Adult')

* Required

Birthday

mm/dd/yy

School

Primary Contact: (Adult students should enter their name in Parent / Guardian Name)

Parent / Guardian Last Name

* Required

Parent / Guardian First Name

* Required

Street Address 1

* Required

Street Address 2

City

* Required

State

* Required

Zip Code

* Required

Work Phone

* Required

Ext.

Home Phone

* Required

Mobile or Alt

* Required

Email

* Required

Confirm Email

Please select one or more of the lesson options:

* Please select at least one.

Please select a Lesson Location

* Required

Please answer the following questions:

Preferred lesson time:

Alt Lesson Time 1:

Alt Lesson Time 2:

If the student has any previous musical experience, please briefly describe:

Does the student have an instrument at home for practice?

Yes No

* Required

If yes, please describe:

Please note that "toy instruments" are not adequate for developing musicians. If you currently do not have an instrument at home, you may enroll today, however our policy states that you should obtain one within one month. Without practice at home, developing musicians are easily frustrated and fall behind in lessons.

Click Register to send this registration to Spainhour Music