Lesson Request *Currently our brass teachers are not teaching due to COVID-19 and the need to wear a mask, if you choose one of these instruments you will be put on a wait list until late fall.* Please note: This form does not automatically sign you up for lessons but gets you in contact with our lesson coordinator for availability options. 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 Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming 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 Guitar Drums Piano Violin Viola Cello Guitar Trumpet* Trombone* Tuba* Flute* Clarinet* Saxophone* Banjo Mandolin Ukulele Recorder* French Horn* Voice Day of the Week that Works Best * Monday Tuesday Wednesday Thursday Friday Saturday Any Time of Day that Works Best * Morning Afternoon Evening Any What Kind of Experience Does the Student Have * Beginner Intermediate Advanced Other 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.