Submit a request – Village Music School

Please choose your issue below

Your email address

Name

example: Sergei Rachmaninoff

Phone Number

required format: 919-333-4444

Billing Address - Street

example: 2240 Gathering Park Cir

Billing Address - Zip Code

example: 27519

Relationship to Student

How did you hear about us?(optional)

Student - Name

example: Taylor Swift

Student - Nickname(optional)

example: Tay Tay

Student - Pronouns

Student - Date of Birth

required format: MM/DD/YYYY

Student - Previous Musical Experience(optional)

example 1: None | example 2: Piano - 2 years

Lesson Details - Type

Lesson Details - Instructor

Lesson Details - Instrument(s)

note: Make sure the selected instructor teaches the instrument(s) that you select.

Lesson Details - Format

note: Make sure the selected instructor offers the format that you select.

Lesson Details - Day of Week

Lesson Details - Start Time

example: 5:30PM

Lesson Details - Duration

Start with an Intro Lesson?

note: An intro lesson is a single lesson after which you can decide if you would like to continue with registration.

I authorize Village Music School to store and charge my credit or debit card.

note: We will send you the steps to provide us with payment details after the registration has been approved.

I have read and accept the terms and conditions.

Subject

Description

Please enter the details of your request. A member of our support staff will respond as soon as possible.

Attachments(optional)

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