Southtown Music Studio

New Student Form

Please tell us about yourself.

Name

First Name

Last Name

Phone

(###)

###

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Who are these lessons for?

Myself

An Adult

A Child

Name of Student if Different

First Name

Last Name

Age and Experience

Tell us a little more the student. Are these lessons for an adult or child (age)? What music or related experience might the student have already encountered formally or informally?

Instrument Interests & Direction

Tell us more about what instruments and directions interest you or the student. Do you or they have any particular needs or goals? Do you have a particular teacher you are interested in or have questions for?