Parent Name

First Name

Last Name

Student Name *

First Name

Last Name

Phone *

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Instrument(s)

What do you play OR want to learn to play?

Drums

Electric Guitar

Acoustic Guitar

Bass Guitar

Vocals

Piano/Keyboard

Ukulele

Saxophone (Alto, Tenor, Baritone)

Flute

Clarinet

Trumpet

Trombone

Other Brass or Woodwinds

Subjects

Music Theory

School Band Tutoring

Performance

Recording/Music Production

Songwriting

Arranging/Orchestration