Application and Inquiry

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Thank you for your interest in the Glim School of Music! Please fill out the information in this for so we may schedule a visit and try to accommodate the student in our schedule. Please see http://glimmusic.com/privacyschool.pdf regarding our privacy policy.

Student Information

Please provide the following information regarding the student who would be attending the lessons.

Last Name, First Name, M.I *

Education Level (ex. 3rd Grade) *

Parent/ Guardian

If the student is a minor

Last Name, First Name, M.I. *

Contact Information

Please provide us with your contact information so that we may reach you.

Cell # *

Other #

E-Mail *

How did you hear about us?

Facebook Group

Facebook Ad

Local Paper

Other Social Group

Friend Referral

Other:

Please continue to next section for scheduling.

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