Parent / Guardian - [Please select] Mr. Mrs. Miss Ms. Dr. First Name * Last Name *
Student - First Name * Last Name *
Student's Age *
Gender: Male Female Neutral/Non-binary
Contact Phone No. *
Email address *
Class interested: (required*) [Please select] JMC (Age 4-5) Music Friends (Age 6-12) Music Wonderland (Age 3) Ode-To-Joy Chorus Private Piano Private Guitar/Electric Guitar/Bass Private Ukulele Private Mandolin Private Vocal Private Violin/Viola Private Cello Private Flute Private Clarinet Private Saxophone Private Drums Theory Other (Please specify in remarks below)
Lesson format: (required*) Online In Person at our School No Preference/First Available
Preferred lesson days: (required*) Check all that applies Mon Tue Wed Thu Fri Sat
The education we provide for your child (or you) is important to us. Please tell us which goals you like your child (or yourself) to achieve in our music program. Check all that applies Develop proficiency on an instrument Build confidence through public performance Participate in a small group experience Improve communication skills Have fun with music Acquire a better sense of self-expression and creativity Improve focus Gain an appreciation for music Enhance cognitive abilities
How did you hear about us? [Please select] Search Engines School Newsletter Yellow Pages Magazines Friends Other
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