Mattock School of Music - Private Lesson Registration

Private Lesson Registration

Student last name

Student first name

Instrument

Playing experience

Date of birth

Grade

School

Availability: Please provide details for each day of the week below

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Other interests

Guardian/primary contact name

Cell phone

Home or work phone

Home address

Secondary guardian/contact name

Cell phone

Home or work phone

Home address

Other important information (medical conditions, learning styles, additional contact, etc)

Are you open to an Apprentice Teacher?

By checking this box, I confirm that I have read and agree to the policies outlined in the Mattock School of Music agreement.