Whole Child Lesson Enrollment

Please review our policies and procedures HERE before signing below

Whole Child Lesson Enrollment Form

First name

Last name

Child's Birthday

Month

Day

Year

Guardian's First and Last Name

Primary Phone number

Email Address

Yes, subscribe me to your newsletter.

What is your communication preference?

Email

Text

Call

What location are you enrolling for?

Hamburg, NY

Williamsville, NY

Bradenton, FL

In Home (must be discussed prior/travel fee applies)

What is your session length preference?

30 minutes

45 minutes

60 minutes

What instrument is the client interested in learning/playing?

Guitar

Piano

Voice

Ukulele

Drums

How did you hear about Bloom?

By signing below I acknowledge the above payment and attendance policy

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