Lesson Request Please note: This form does not automatically sign you up for lessons but gets you in contact with our lesson coordinator for availability options. *Please do not submit this form unless you are ready to begin lessons as teacher's schedules do change. Student's Name (First and Last) * Parent/Guardian's Name (First and Last) (Required If Student is under 18) Age of Student (If student is under 18) Student's Address * Student's Address Student's Address Student's Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Email Address * Enter Email Confirm Email Address * Confirm Email Primary Phone Number * Parent/Guardian Phone Number (If Student is Under 18) Instrument * Bass GuitarDrumsPianoViolinViolaGuitarTrumpetTromboneTubaFluteClarinetSaxophoneBanjoMandolinUkuleleRecorderFrench HornVoiceUpright Bass Day(s) of the Week that Work Best Monday Tuesday Wednesday Thursday Friday Saturday Any Day Time of Day that Works Best * Morning (10:00 a.m.-12:00 p.m.) Afternoon (1:00 p.m.-4:30 p.m.) Evening (5:00 p.m.-8:00 p.m.) Any What Kind of Experience Does the Student Have * BeginnerIntermediateAdvancedOther What Kind of Experience Does the Student Have Comments How would you like to be contacted? * Email Phone **Please only hit the submit button once. It may take a second or two for the green confirmation message to appear** If you are human, leave this field blank.