Music Lesson Application

Contact Person's Name*

First Last

How Would You Like Us to Contact You?*

(Select all that apply)

Home Phone
Cell Phone
Work Phone
Email
Mail

Home Phone

Cell Phone

Would You Accept Text Messages?

Yes
No

Work Phone

Email

Confirm Email

Address

Street Address Address Line 2 City State ZIP Code

Note:

We Are Located At 12049 Woodsboro Pike, New Midway, MD 21775

Days Available

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

Time of Day Available

Early Afternoon
Late Afternoon
Early Evening

How Many Students Will Be Taking Lessons?*

Student Info

Student's Name

Student's Age

Which Instrument(s) Would the Student be Interested in Learning?*

Piano
Guitar
Ukulele
Voice
Other

If "Other," please specify.

Does the Student Have an Instrument to Practice on at Home?

Yes
No

Would You Like Information About Purchasing from Kramer's?

Yes Please
No Thanks

Skill Level

Beginner
Intermediate
Advanced

What Music Styles Does the Student Enjoy?

Any Previous Experience?

Any Special Notes for the Teacher?

How Did You Hear About Us?

Family/Friend Referral
Facebook
Newspaper/agazine Ad
Other Website
Internet Search
Event
Other

Which Newspaper/ Magazine Ad?

Which Website?

Which Event?

If "Other," Please Specify.

Student #2 Info

Student's Name

Student's Age

Which Instrument(s) Would the Student be Interested in Learning?*

Piano
Guitar
Ukulele
Voice
Other

If "Other," please specify.

Does the Student Have an Instrument to Practice on at Home?

Yes
No

Would You Like Information About Purchasing from Kramer's?

Yes, Please
No, Thanks

Skill Level

Beginner
Intermediate
Advanced

What Music Styles Does the Student Enjoy?

Any Previous Experience?

Any Special Notes for the Teacher?

How Did You Hear About Us?

Family/Friend Referral
Facebook
Newspaper/magazine Ad
Other Website
Internet Search
Event
Other

Which Newspaper/ Magazine Ad?

Which Website?

Which Event?

If "Other," Please Specify.

Student #3 Info

Student's Name

Student's Age

Which Instrument(s) Would the Student be Interested in Learning?*

Piano
Guitar
Ukulele
Voice
Other

If "Other," please specify.

Does the student Have an Instrument to Practice on at Home?

Yes
No

Would You Like Information About Purchasing from Kramer's?

Yes Please
No Thanks

Skill Level

Beginner
Intermediate
Advanced

What Music Styles Does the Student Enjoy?

Any Previous Experience?

Any Special Notes for the Teacher?

How Did You Hear About Us?

Family/Friend Referral
Facebook
Newspaper/magazine Ad
Other Website
Internet Search
Event
Other

Which Newspaper/ Magazine Ad?

Which Website?

Which Event?

If "Other," Please Specify.

Student #4 Info

Student's Name

Student's Age

Which Instrument(s) Would the Student be Interested in Learning?*

Piano
Guitar
Ukulele
Voice
Other

If "Other," please specify.

Does the Student Have an Instrument to Practice on at Home?

Yes
No

Would You Like Information About Purchasing from Kramer's?

Yes Please
No Thanks

Skill Level

Beginner
Intermediate
Advanced

What Music Styles Does the Student Enjoy?

Any Previous Experience?

Any Special Notes for the Teacher?

How Did You Hear About Us?

Family/Friend Referral
Facebook
Newspaper/magazine Ad
Other Website
Internet Search
Event
Other

Which Newspaper/ Magazine Ad?

Which Website?

Which Event?

If "Other," Please Specify.

Student #5 Info

Student's Name

Student's Age

Which Instrument(s) Would the Student be Interested in Learning?*

Piano
Guitar
Ukulele
Voice
Other

If "Other," please specify.

Does the Student Have an Instrument to Practice on at Home?

Yes
No

Would You Like Information About Purchasing from Kramer's?

Yes, Please
No, Thanks

Skill Level

Beginner
Intermediate
Advanced

What Music Styles Does the Student Enjoy?

Any Previous Experience?

Any Special Notes for the Teacher?

How Did You Hear About Us?

Family/Friend Referral
Facebook
Newspaper/magazine Ad
Other Website
Internet Search
Event
Other

Which Newspaper/ Magazine Ad?

Which Website?

Which Event?

If "Other," Please Specify.

Lessons

Note:

Student Info

Student #2 Info

Student #3 Info

Student #4 Info

Student #5 Info

Thank You