Request a Private Lessons

Parent(s) Name *
Parent(s) Name
Primary Phone
Primary Phone
Student's Name *
Student's Name
Student Birthdate
Student Birthdate
Student's Instrument of Interest
Check all that apply
If there is a strong preference for a lesson (e.g. Mondays at 8pm), we will do our best to accommodate it, on a first-come, first-serve basis. We recommend listing a few options.
Only those that could be encountered at the Rock Stop.
Emergency Contact
Emergency Contact
Only used in the event the parent(s) are not reachable.
Phone Number
Phone Number
Is there anything else we should know about?
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