New Student Registration

Please complete the following form and click "submit" at the bottom of the page. You will then be contacted by our administrative staff to schedule an appointment for your first lesson.

Not all of the fields apply to everyone. Please complete the parts of the form which apply to you.

Details of Student:

Student's Full Name:
Student's Primary Email:
Student's Secondary Email:
Student's Cell Phone Number:
Name of School/College or Place of Work:
School Grade Level:
Date of Birth:
Name of Band Director or Music Instructor:
Street Address:
Street Address Cont.:
City:
State:
Zip Code:

Desired Lesson Length: 1/2 Hour or Full Hour
Desired Weekly Lesson Time (please see our Availability page):
Please keep in mind that there is a discount for lessons which fall under the
Non-Prime Time parts of our schedule.
Day:

Time:

Is the student currently a Home Schooled student? (special discounts apply):

We do have student instruments for rental. Do you need to rent a trumpet?

Where did you hear about Eddie Lewis?

Details of Parents/Guardians

(Applicable to minors ONLY.)

Father's Name:
Father's Email Address:
Father's Cell Phone No:
Work/Day Phone No.:
Alternative Phone Number:
Mother's Name:
Mother's Email Address:
Mother's Cell Phone Number:
Mother's Work/Day Phone Number:
Mother's Alternative Number:
Secondary Email Address for Parents:
Billing Address (if different from above):