Rachel Loerts Music Trial Lesson Request Form
Please fill out this form to request a trial lesson for yourself/your child. Trial lessons have a one-time fee of $20 for a 1/2 hour and $40 for 1 hour.
Student's Name *
First and last name
Your answer
Age *
Your answer
Birthday *
MM
/
DD
/
YYYY
Allergies/Dietary Restrictions
(if applicable) Please note that there is at cat in the house, but it does not go into the music room where lessons are taught.
Your answer
Instrument *
Required
Lesson Length *
Musical Interests *
Check all that apply.
Required
Level *
Preferred Lesson Date and Time
Sundays (all instruments) 9 am until 5 pm,
Wednesdays (voice & piano only) 3:30 pm until 9 pm

View a calendar of taken lesson times here: http://www.rachelloertsmusic.com/lesson-information.html

Top three preferred trial lesson dates and times
Please note that after the trial lesson, this time does not have to be your regular weekly lesson time.
First Choice *
(eg. Wednesday 4-4:30)
Your answer
Second Choice
Your answer
Third Choice
Your answer
Parent/Guardian Name(s) *
Your answer
Parent/Guardian Phone Number(s) *
And/or student's number.
Your answer
Parent/Guardian Email Addresse(s) *
And/or student's email address.
Your answer
How did you hear about Rachel Loerts Music? *
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