^{SHJA REGISTRATION FORM}

Policies

   

Agree to our Policies *

• Confirm

In person, online or both? *

• At school (in person)
• Live stream (internet)
• Interchangeable

Payer Information *

First

Last

Street Address *

City / Town *

Select State (copy) *AKALARAZCACOCTDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVTVAWAWVWIWY

Zip Code *

Email *

Phone Number *

Student Name(s) *

First

Last

Student Name 2 (shared)

First

Last

Student Address Information *

• Same address
• Different address

Responsible Person *

Street

StateAKALARAZCACOCTDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVTVAWAWVWIWY

Zip Code

Student Email

Student Experience Level *

• Beginner
• Advanced Beginner
• Intermediate
• Experienced Player

Birthday (student 1) *

Birthday (student 2)

Instruments Menu *CHOOSE FROM LISTBanjoBass GuitarDrumsGuitarMandolinPianoUkuleleViolinVocalsAudio EngineeringMusic TheoryOther

Lesson Type *

• 1/2 Hour Private
• 1 Hour Private
• 1/2 Hour Shared
• 1 Hour Shared
• Add Band
• Band Only

Start Lessons *

• First Opening
• Next Week
• Other

Desired Start Date (Other)

Weekday - First Preference

• Any open week day
• Monday
• Tuesday
• Wednesday
• Thursday
• Friday (2:00-6:00)
• Saturday (see below)

Time Range

• 3:00 - 5:00
• 5:30 - 7:30
• Any opening

Weekday - Second Preference

• Monday
• Tuesday
• Wednesday
• Thursday
• Friday (2:00-6:00)

Time Range

• 3:00 -5:00
• 5:30 - 7:30
• Any opening

Saturday - First Preference

• 11:00-12:30
• 12:30-2:30
• Any opening

Saturday - Second Preference

• 11:00-12:30
• 12:30-2:30
• Any opening

Information or Questions:

How Did You Find SHJA?

• Web Search
• Drive By
• Advertisement
• Face Boook

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