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:  

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):      

       Birthday Parties - hosting party at the studio Brass Instrument (Trumpet, Trombone, etc.) Guitar: Acoustic Guitar Exploration Class - Sampler Class, ages 5-10yo Guitar: Electric Guitar: Suzuki (suggested for children under 8yo) Kids Off Broadway Camp - Summer Camp (summer only) Kids Off Broadway Workshop - school year Percussion (drumset, etc.) Piano Camp (summer only) Piano Exploration - Piano Sampler Class, ages 3-6yo and 7-10yo Piano: Private, Suzuki (suggested for ages 3-8yo) Piano: Private, Traditional RockShop - guitar/bass/drums, small ensembles Small Ensemble Songwriting Strings, other than violin (viola, cello, string bass) Summer Camps Theory Violin Exploration Class - Sampler Class, ages 3-10yo 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

Where do you prefer to have your lessons?   > Choose one... In the Powell studio In Our Home Either is fine - no preference

Will you accept the other location if your preference is not available?   Choose one... Yes No

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!

We are happy to meet with families interested in enrolling with us for lessons or classes so that we can develop a relationship with you to provide you with the best possible customer service.  If you are interested in meeting with us, please list your general availability for a meeting at the studio, and the Director or Assistant Director will contact you to schedule an exact day and time.  For this meeting: please schedule a day and time; parents only, please, whenever possible; and, if you would like to bring your child to the studio, we prefer that you schedule a second appointment.  Should you need to bring your child, please bring an activity as childcare is not available.  This appointment should last 15-45 minutes.               

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!