Funkytown lessons registration

PRIVATE LESSON ENROLLMENT

Complete this form to get a complimentary trial music lesson. Funkytown helps students of all ages and abilities develop as a musicians on:
-violin
-drums
-piano
-voice
-electric and acoustic guitar
-ukulele
-bass guitar
-saxophone, clarinet, and flute

Student Information

Student name

Student birthdate

Who is filling out this form?

What is your relationship to the student?

Please select one option.

I'm the student Mom Dad Grandparent/other family member Other

Your phone number

Your email address

This address will receive a confirmation email

Student's primary phone number (if different)

Home address

If applicable, what school does the student attend?

If applicable, what grade is the student in/entering?

Music background

What instrument(s) is the student interested in learning?

Please select all that apply.

violin voice guitar piano/keyboard bass guitar saxophone flute clarinet drums other

What instruments does the student ALREADY play?

How long has the student studied music?

Please select one option.

just getting started 0-1 years 1-5 years 5+ years

Referral information

How did you hear about Funkytown Music Academy?

Please select all that apply.

Facebook/Instagram saw a flier/sign University United Methodist Church (including website) referred by a friend Google search

If a friend referred you, please share their name.

If you have friends or family who may be interested in growing as musicians, please include their name and contact information here.

Funkytown lessons registration

Description

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