Semi-Private Music Classes | Performance Play Music School

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Student Information

Name*

First Last

Your Instrument*

Years of Lessons*

Preferred type of music*

List favorite 3 bands, artists, OR songs*

Age*

Second Child's Name*

First Last

Second Child's Instrument*

Second Child's Years of Lessons*

Second Child's preferred type of music*

Second Child's favorite 3 bands, artists, OR songs*

Second Child's Age*

Third Child's Name*

First Last

Third Child's Instrument*

Third Child's Years of Lessons*

Third Child's preferred type of music*

Third Child's favorite 3 bands, artists, OR songs*

Third Child's Age*

Parent's Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Primary Phone*

Secondary Phone

Can we text this number with our current lesson options?

Can we text this number with our current lesson options?

Email

Comments

What length of lesson are you interested in taking?

Preference 1: Day

Time

Preference 2: Day

Time

Preference 3: Day

Time

Name

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