QMA Registration Form
Student's Full Name
*
Email
*
Phone Number
*
Student's Age
*
Level?
*
Beginner
Intermediate
Advanced
Private or Group Lessons?
*
Private lesson
Group Class
Instrument? (Can select multiple)
Piano
Guitar
Bass Guitar
Cello
Violin
Viola
Woodwind
Brass
Drums
Vocal
Ukulele
Preferred Days?
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Preferred Time?
*
Between 3-5 pm
Between 5-7 pm
Between 7-9 pm
Between 10am - 12 pm (weekends only)
Between 12 - 3 pm (weekends only)
Special Requests (Time, Teacher Preference)
Interest in Group Lessons?
Group Piano
Kids Rock Band
If interested in Rock Band, which instrument?
Bass Guitar
Drums
Guitar
Piano/Keyboard
Vocal
Other...
How did you hear about us?
Special requests/notes
Submit