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Student Name*

Address*

City *

Email *

Phone *

Age of Student (if under 18)

Parent Name (if student is under 18)

What best describes your level of guitar playing?

Guitar(s) currently owned
NoneElectricAcousticBassClassical

If you don't have an instrument, would you like help selecting one?
YesNo

Do you read music?
YesNo

Check the type of music you wish to study?
BluesClassical RockModern RockMetalCountryFolkClassicalJazzPraise & Worship

List the days and times you are available to take lessons:
Monday: AfternoonEvening
Tuesday: AfternoonEvening
Wednesday: AfternoonEvening
Thursday: AfternoonEvening
Friday: Afternoon
Saturday: Afternoon

Special Requests (i.e., Time, Teacher, Questions, Etc.)