Book Lesson

Student Name

Parent/Carer Name (if under 18yrs)

Home Address

Postcode

Email Address

Phone Number

Student Age

Please Select from the options below 0-3 years of age 4-7 years of age 8-12 years of age 13-18 years of age Adult (Over 18)

Instrument

Please Select from the options below Piano Keyboard Guitar Ukulele Banjo Drums Violin Viola Singing/Vocals Music Theory Brass Woodwind Strings

Experience

Please Select from the options below Beginner (No experience) Intermediate (Some experience) Advanced (Lots of experience)