Parent's First and Last Name * First Name Last Name Parent E-mail * Parent Phone * (###) ### #### Preferred Contact Method E-Mail Phone Call Text Message Student's First and Last Name * First Name Last Name Student's Date of Birth * MM DD YYYY What instrument are you interested in studying? * Brass: Alto Horn Brass: Baritone Brass: Euphonium Brass: French Horn Brass: Trombone Brass: Trumpet Brass: Tuba Cello Flute Guitar: Acoustic Guitar: Electric Percussion: Drum Set Percussion: Orchestral Piano Ukulele Viola Violin Voice: Classical/Opera Voice: Jazz Voice: Musical Theater Voice: Contemporary/Pop Please tell us about your prior music experience and list any teachers you've studied with. * Do you have an instrument at home for practice? If yes, what kind? * What are your goals for private lessons? * Is there a specific teacher you are interested in studying with? How did you hear about us? * Friend/Family Referral Facebook Instagram Yelp X Youtube Irvine Moms News/Publication Flyer/Poster/Postcard E-Mail Instructor/Staff Referral Other If you were referred by another student or an instructor, please tell us who. Disclaimer By clicking “Submit”, you agree to OC Music and Dance’s Privacy Policy. You consent to receive phone calls and SMS messages from OC Music and Dance to provide information regarding your lessons, classes, ensembles, and/or upcoming events. Message frequency depends on your activity. You may opt-out by texting ‘STOP”. For assistance reply “HELP”. Message and data rates may apply. Thank you!Thank you for your inquiry. A member of our team will be in contact with you shortly.Back to Programs Want to Join the School of Music?
