Sign-Up Form

Complete and submit the form below and you will be contacted to schedule your complimentary introductory lesson.

Submitting this form will make you eligible for my Introductory Discount!

Date (required)

Name of Student (required)

Student's Email (required)

Date of Birth (required)

If student is a minor - Parent's name(s)

Parent's Email

Parent's Email 2

Address (required)

Address Line 2

City (required)

State (required)

Zip (required)

Home Phone

Mobile Phone (required)

Work Phone

Preferred method of contact: email or phone? (required)

(If phone, please specify: home; work; or mobile)

Please list any food allergies or medical conditions:

How long have you been playing drums?

Right-handed or Left-handed?

What styles do you play?

What styles do you want to learn/improve?

What groups and/or drummers do you like?

Have you played in a group before? Are you currently in a group?

Do you read music?

Do you play any other instruments?

Please use the area below for any questions. Thank you!