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)