East Valley School of Music - Group Class Interest Form

Class of Interest *

Do you own/rent an accoustic, 88 weighted key piano? *

If other, please explain: *

Student Name *

First

Last

Age of Student *

Parent Name (if under 18) *

First

Last

Student's Date of Birth (if under 18) *

Example: MM/DD/YYYY

Contact Email *

Example: office@evsm.net

Contact Phone Number *

Example: 480-895-0007

Does the student have any special needs? *

If yes, please decribe: *

How did you hear about us? *

If referred, whom shall we thank?

If other, please explain:

How would you like to proceed? *

Preferred Method of Contact: *

Questions or Concerns