Drop-In Student Booking Form (already registered)

Please check which instrument(s) you would like to register for:

Lesson Length Lesson Length

Lesson date(s) & time(s) requested (minimum 72 hours notice required): *

Alternate Lesson date(s) & time(s) if first request is not available: *

Name *

First

Last *

Last

Phone Number (please leave blank if your information does not need to be updated from your registration)

Email *

Student Name *

Address (please leave blank if your information does not need to be updated from your registration)

Number and types of pets (please leave blank if your information does not need to be updated from your registration)

Relevant Medical Information (please leave blank if your information does not need to be updated from your registration)

Name of and relationship to student of the person most likely to be home during the lesson

Emergency contact information. Name, Cell Phone, Relationship to student. (Someone other than the person most likely to be home during the lesson)

Musical background (if any) and muscial goals. Please list any current material you are working on or would like to start learning.

I would like to use the following method of payment to secure my drop-in lesson(s) *

I understand that: 1) once the date(s) above is/are confirmed by email/text, the lesson is transferable but not eligible for a refund/credit/makeup lesson and that I will need to purchase another drop-in lesson if I need to reschedule. 2) payment is required, in full, at the time of this request and that should Music for Life not be able to facilitate lesson date then I will be refunded or credited *

Agree

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