Student Referral Card
Student Name
Age
Parent or Contact
Phone #
e-mail
Instrument
-Select One-
Guitar
Electric Bass
Piano
Drums
Voice
Flute
Clarinet
Soprano Sax
Alto Saxophone
Tenor Saxophone
Baritone Saxophone
Trumpet
Trombone
Baritone Horn
French Horn
Tuba
Recorder
Violin
Viola
Upright Bass
Didgeridoo
Lute
Banjo
Ukulele
Level
Do You Prefer A Particular Teacher ?
Bill Decker
Keith Richman
Ervin Hagler
Steve Hoffman
Paul Gruen
Ari Camarota
Alastair Ingram
Carrie Crandall
Pete Estabrook
Gary Meierhenry
Dale Gutridge
Paul Hadley
Melanie Webster
Megann Resso
Jean Young
Stephen Riedel
Mike Emerson
Shawna Miller
Pat O'Connell
No Preference
Any Other Information You May Wish To Include: