Student's Name *

First Name

Last Name

Gender *

Male

Female

Parent Name (if student is under 18 yrs of age)

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Primary Phone Number *

(###)

###

####

Alternative Phone Number

(###)

###

####

I am interested in: *

30 minute lesson slot

45 minute lesson slot

45 minute lesson slot, but if unavailable I will take a 30 min. lesson slot

Being added to the waiting list if there are no open lesson slots currently

How did you find out about Blake Music Studios? *

Flier

Facebook Classified Ad

Internet Search

Friend or Referral

Poster

Other

I understand that Tuition for Private Voice Lessons is $120 per month, per student for 30 min. lessons and $175 per month, per student for 45 minute lessons. I understand that payment is due at the FIRST LESSON of each month. *

Yes

No