:: MUSIC LESSONS ages 12+ :: Piano, Guitar, Voice, Percussion ::

So you want to take music lessons...

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LOCATION: Western Suffolk Va.
(Just off of Rt.58 between Holland & Franklin)

Watch Kate Teach on YOUTUBE:
"Learn to Recognize Chords in 15 Minutes"

- Entrance ('Get to know you') Form -
After reviewing the lesson guidelines, please fill in the following form.
Kate will then contact you about scheduling an Entrance Interview.

*Required fields

Full Name*	Phone Number* (numbers only, no spaces)
Age* Parent or Guardian (if under 18)
Desired Lesson Time
Email Address* (If you would like to use Paypal to pay lesson fees, please provide an email address that is registered on your Paypal acct.)	Full Mailing Address*
How did you hear about these music lessons*?	What would you like to learn? Check one or more: Piano Guitar Percussion Voice
Do you play other instruments? Yes No	If so, what instruments?
What Do You Already Know?
Key Signatures? Yes No	Time signatures? Yes No
Major and minor scales? Yes No	Chord charts? Yes No
Improvise / play by ear? Yes No	Sight reading? Yes No
How Do You Hear?
Do you usually learn (songs or anything) by reading or hearing? Hearing Reading	How much time do you spend in an average day listening to music?
Are you drawn more to the voices (melody) or instruments (accompaniment)? Voices Instruments	When you hum a familiar tune, what do you hear in your head? Do you hear the melody, or the whole arrangement? Just melody Whole band
What Do You Want?
List three goals, interests, or preferences that you want to pursue in your lessons. This is the most crucial part of this worksheet. Please take as much time as you need to answer. An interview can not be scheduled until this portion is completed. The only wrong answer is no answer…
Comments / Questions?* (Why do you want lessons?)	Goal 1*
	Goal 2*
	Goal 3*
	I have read and accept the Lesson Guidelines* Yes No

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