Free Guitars for Future Stars

Program Application

Student Name*

Student Age*

Parent or Guardian Name*




Zip Code*


Primary Phone Number*

Alternate Phone Number

Preferred method of contact:
 Phone Email Either

Are you Left-handed or Right-handed?
Left-handed Right-handed 

Do you currently own a guitar?*
 Yes No

If so, what kind(s)?
 Acoustic Electric Acoustic/Electric Bass

Have you taken guitar lessons?*
 Yes No

Do you play another instrument?*
 Yes No
If so, which instrument(s)?

Which city or cities are you available for lessons?*
 McHenry Crystal Lake Woodstock Harvard Marengo

If you selected multiple cities, which is your preferred choice?*
 McHenry Crystal Lake Woodstock Harvard Marengo

Which would be provided as proof of low-income status?*
 Free/Reduced Lunch Status Link Card SSI Check Other
If Other, what would it be:

Are you in:
Middle school High school 

Can we use your photo for promotional use (on our website/marketing materials?
Yes No 

How were you referred you to us?

Referral contact name:

* - Required fields