Registration

Emma Shubin, flutist, Suzuki flute teacher, Integrative and Dalcroze Eurhythmics Educator, Louisville, Lafayette, Boulder, Superior, CO, Front Range, Rocky Mountain Region, Colorado, online flute lessons and instruction, Skype, FaceTime, google hangouts

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Liability & Studio Policy Release

Registration

Have you submitted this form before and just want to buy your next lesson package? Go directly to the payment page!
If not, pretty please, don't skip this page, thank you!

Register for flute, beginning/intermediate piano & musicianship lessons for all ages:

* Indicates required field

Parent/Contact Name *

First

Last

Email *

Phone Number *

Student Name *

First

Last

Sibling Name *

First

Last

Age/Grade *

Sibling Age/Grade *

Gender *

Male Female

Sibling Gender *

Male Female

School *

Sibling: School *

Years Playing (if any) *

Sibling: Years Playing (if any) *

Interested in: *

Flute Lessons Piano Lessons Dalcroze based musicianship/improvisation

Sibling - Interested in: *

Flute Lessons Piano Lessons Dalcroze based musicianship/improvisation

Do you participate in a school/community band/orchestra/choral program? *

Yes No

Sibling - Do they participate in a school/community band/orchestra/choral program? *

Yes No

What lesson length are you interested in? *

30 mins 45 mins 60 mins other (please specify in the comment section)

Sibling - What lesson length are they interested in? *

30 mins 45 mins 60 mins other other (please specify in the comment section)

How many lessons are you interested in taking? *

on-going (36-lesson academic year) on-going (monthly) single package - 4 lessons single package - 8 lessons single package - 12 lessons

Sibling - How many lessons are they interested in taking? *

on-going (36-lesson academic year) on-going (monthly) single package - 4 lessons single package - 8 lessons single package - 12 lessons

Do you own a flute or piano? *

Flute Piano Both

Sibling - Do they own a flute or piano? *

Flute Piano Both

Comment *

Continue to Liability and Studio Policy Release

Emma Shubin, Flutist | 585.704.5751 | emma@emmashubin.com | www.emmashubin.com
original web design by Jessica Sherer • updates and new designs by Emma Shubin • photography by Rebekah West