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Prairie Music & Arts Private Music-Lesson Registration Form: 2019-2020
This registration form is for parties interested in private one-on-one music lessons in the following disciplines: piano, voice, strings, guitar, ukulele, low brass, trumpet, and drum set. Please review the 2019-2020 Private-Lesson Package document for specifics regarding age requirements per instrument, cost per lesson/package, and structure of private-lesson program before completing this form.

GRADE LEVEL REQUIREMENTS: Grades K-1 are eligible for piano or violin lessons upon assessment and recommendation from our Program Director. Guitar, Ukulele, Wind instrument, and Drum-Set students must be in fourth grade or have at least one year of private instruction with a previous instructor. Voice students must be in seventh grade or have at least one year of previous private voice instruction. All new 2019-2020 students may be asked to take a trial lesson/readiness assessment prior to registering for weekly lessons.

Last Name of Student *
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First Name of Student *
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Student's Date of Birth *
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Student's Grade Fall 2019 *
School Attending
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Email Address: Please list the email(s) most frequently checked in your household. PMA's primary source of school communications is via email.
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Primary Phone Number: Please list the phone number of the primary parent/caregiver contact of the student being registered. Please format (000) 000-0000 *
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Parent #1 First & Last Name *
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Parent #1 Phone (Cell Phone) Please format (000) 000-0000 *
Your answer
Parent #2 First & Last Name
Your answer
Parent #2 Phone (Cell Phone) Please format (000) 000-0000
Your answer
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