Salutation:   Choose... Mr. Mrs. Ms. Dr.

Adult's First and Last Name (must be an adult or parent of a child): 

Home Address:  

City:       State:       Zip:  

Please describe where you are located, including nearest major cross streets.  

Home Tel with Area Code:   (ex: 6145551212)

Work Tel with Area Code:  (ex: 6145551212)

Cell with Area Code:   (ex: 6145551212)

Fax with Area Code: (ex: 6145551212)

Other Tel with Area Code: (ex: 6145551212)

E-mail address (*required): 

Please select the instrument or class below for which you would like to receive additional information (hold down the shift or ctrl key to make multiple selections):      

       Brass Instrument (Trumpet, Trombone, etc.) Guitar: Acoustic Guitar: Electric Guitar: Suzuki (suggested for children under 8yo) Percussion (drumset, etc.) Piano: Private, Suzuki (suggested for ages 3-8yo) Piano: Private, Traditional Songwriting Strings, other than violin (viola, cello, string bass) Theory Violin: Suzuki (suggested for students of all ages) Violin: Traditional Voice Woodwinds (Flute, Clarinet, Sax, Oboe, etc.)

Please explain any prior experience the student has had on the instrument(s) or in the class(es) you have selected above:

      none

In Cleveland, we only provide lessons at your location. Where would you prefer to have your lessons? A legal parent/guardian must be present for a child's lesson.   Choose one... In our home In our school Other location to be discussed such as a church, neighbor's house, etc.

Where did you hear about us (hold down the shift or ctrl key to make multiple selections)? We would greatly appreciate your being very specific!

Do you need information on instrument rental or purchase?  If so, please explain in detail so that we can forward the information to you. Students do need to have their own instruments on which to practice during the week and for the lessons (except for pianos - we provide those at the studio for the lessons, but a piano is needed at home for practicing).

We would appreciate any additional information regarding the students, their ages, their prior experience in music, names of children, etc.  Please mention any specific or pertinent information here. GIFT CERTIFICATES: If this is a gift certificate for someone, please be sure to let us know the name of the person to whom you will be giving the gift and the date by which you need the certificate. SENIOR CITIZENS: If you are a senior citizen, be sure to let us know so that you can receive the special discount. Thank you!

Thank you for submitting your request!  Please be certain that your form is completed in full. We will contact you as quickly as possible.  You may also wish to call us at 888.58.PRESTIGE.

THANK YOU IN ADVANCE FOR YOUR BUSINESS!