#1 Enter Parent / Guardian Name (required)
Last Name
First Name
#3 How Did You Hear About Us? (required)
#4 Student Name / Grade (required)
Full Name
Current school grade or 'Adult'
#7 Designate an Emergency Contact (required)
Emergency Contact Name
Emergency Contact Phone (xxx-xxx-xxxx)
#8 Enter any special notes (optional)
#2 Enter Mailing Address and Phone Numbers (required)
Street
City
Zip
Primary Phone xxx-xxx-xxxx
Cell Phone xxx-xxx-xxxx
Email
#6 Available Days -- Check all that apply (required)
Please list available times for those days:
#5 Instrument (required)
CONSULTATION LESSON REGISTRATION
Thank you for your interest in VPA's School of Music! Complete the form below. Click 'submit' and you will be directed to Paypal which will process your $20 Consultation Fee securely. Note: You do not need a paypal account in order to submit a payment.
An instructor will call you directly within the next two business days to schedule your appointment. Consultations must be scheduled within two weeks of purchase. Consultation Fee is non-refundable unless VPA is unable to accommodate the lesson.
(847) 998.9900
