Amped! Pre-Registration Form

Student's Name (required)

Student's Age (required)

Your Email (required)


Guardian's Name (if applicable)

Contact Home Telephone

Contact Mobile Telephone

Billing Address


Are you a current student?
YesNo

Please answer the questions below to help us place you in an appropriate group.

Instrument(s) you play (if applicable)

How long have you been playing?

How much time do you intend to practice each week?

How much time will you spend in private lessons?

Days And/Or Times You CAN Do

Days And/Or Times You CANNOT Do

Which other students do you know want to be in your group?

captcha (please type this - not case sensitive)