QMA Registration Form
Participant's Full Name*
Email*
Phone*
Student's Age*
Level?*
Beginner
Intermediate
Advanced
Type of Lesson?*
Private lesson
Group Class
Instrument ( you can choose more than one)*
Bass Guitar
Cello
Drums
Flute
Guitar
Sax
Trumpet
Trombone
Ukulele
Violin
Vocal
Other..
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 (flexibility on day and time, Preferred teacher etc...)
Interested in Group Classes?
Rock band (ages 8-15)
Guitar Class (adult)
Keyboard group
Violin Group
Kids Rock Band (ages 4-7)
Songwriting Class
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