Trial Lesson Request

Disclaimer: Trial lesson fees are the same as regular tuition rates. Please be prepared to pay the day of your trial lesson with cash or a check made out to Midwest Conservatory of Music, LLC.

STUDENT NAME:

First Name

Last Name

Today's Date

Student's age, if under 18

PARENT/GUARDIAN INFO:

Prefix

First Name

Last Name

Parent/Guardian Mailing Address

Street Addess

Street Address Line 2

City

State / Province

Postal / Zip Code

Parent/Guardian E-mail

Parent/Guardian Phone Number

Alternate E-mail

Alternate Phone Number

Emergency Contact

Relationship to student

Emergency Contact Phone Number

Instrument:

Lesson Teacher

Lesson Length

Lesson Day

Current Student or Newly Enrolled Student

Please tell us if this student has any health concerns or learning disabilities of which the instructor should be aware:

Signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

MCM Enrollment Form

Please reach out to info@midwestconservatory.com with any questions.

STUDENT NAME:

First Name

Last Name

Today's Date

Student's age, if under 18

PARENT/GUARDIAN INFO:

Prefix

First Name

Last Name

Parent/Guardian Mailing Address

Street Addess

Street Address Line 2

City

State / Province

Postal / Zip Code

Parent/Guardian E-mail

Parent/Guardian Phone Number

Alternate E-mail

Alternate Phone Number

Emergency Contact

Relationship to student

Emergency Contact Phone Number

Instrument:

Lesson Teacher

Lesson Length

Lesson Day

Current Student or Newly Enrolled Student

Please tell us if this student has any health concerns or learning disabilities of which the instructor should be aware:

Signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.