Student InformationStudent Name* First Last Date of Birth* MM slash DD slash YYYY Age*GenderSelect...FemaleMaleOtherEthnic CategoryFor analysis purposes only.Select...American Indian or Alaskan Native (Not Hispanic or Latino)Asian (Not Hispanic or Latino)Black or African American (Not Hispanic or Latino)Hispanic or LatinoMultiracial/Two or More Races (Not Hispanic or Latino)Multiracial/Two or More Races (Including Hispanic or Latino)Native Hawaiian or Pacific Islander (Not Hispanic or Latino)White (Not Hispanic or Latino)Phone*Email* Enter Email Confirm Email Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code School*If not in school, please enter None Parent InformationParent/Guardian Name First Last PhoneEmail Enter Email Confirm Email Lesson InformationLessons*Select...TrumpetMellophoneFrench HornTromboneBaritoneEuphoniumTubaFluteClarinetSaxophoneColor GuardField ConductingPacific Crest will match you with one of our private instructors; however, if you wish to request a specific instructor, you may enter their name in the next field. We will do our best to accommodate you.Instructor Requested (optional) Lesson Type*Select...45-Minute Lesson (4-Pack) - $150Private Lesson TermsSchedule* I/We agreeLessons must run on schedule in order to not interrupt the flow of other lessons scheduled with the same teacher. Missed Lessons* I/We agreeMissed lessons may be made up at another time, but no refunds will be granted. Instructor Assignment* I/We AgreePacific Crest reserves the right to reassign a private music lesson student to a different instructor if necessary. Cancelled Lessons* I/We AgreeIf the lesson cannot start on time, it will not be cancelled for a period of up to the first 10 minutes. If the lesson does not commence within the first 10 minutes, all parties agree to treat the tardy as a missed lesson and agree to arrange a make-up lesson.Student Signature* Enter full name.Parent Signature* Enter full name.Signature* I/We AcceptI/We understand that checking this box constitutes a legal signature confirming that I/we acknowledge and agree to the above terms of the Pacific Crest Private Lessons Program.CAPTCHAHiddenRegistrationID* NameThis field is for validation purposes and should be left unchanged.