PROGRAM APPLICATION Student Name* Student Age* Parent or Guardian Name* Address* City* State* Zip Code* Email* Primary Phone Number* Alternate Phone Number Do you internet access if we need to go to online lessons?* YesNo Are you Left-handed or Right-handed? Left-handedRight-handed Do you currently own a guitar?* YesNo If so, what kind(s)? AcousticElectricAcoustic/ElectricBass Have you taken guitar lessons?* YesNo Do you play another instrument?* YesNo If so, which instrument(s)? Which city or cities are you available for lessons?* McHenryCrystal LakeWoodstockHarvardMarengo If you selected multiple cities, which is your preferred choice?* McHenryCrystal LakeWoodstockHarvardMarengo Which would be provided as proof of low-income status?* Free/Reduced Lunch StatusLink CardSSI CheckOther If Other, what would it be: Are you in: Middle schoolHigh school Can we use your photo for promotional use (on our website/marketing materials? YesNo How were you referred you to us? Referral contact name: * - Required fields