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Student Type*
Youth/Child (Under 18)
Adult - SKIP PARENT INFORMATION
Preferred Phone Number*
Are you interested in our current promotions?*
Yes - ALL required sticks, mallets, and drum pad included FREE with 12 months of lessons.
Yes - Include drum set or cymbals with 18 months of lessons.
Yes - Include Pearl Malletstation with 24 months of lessons.
Yes - Lets talk about a custom instrument package included.
Not at this time.
How did you hear about us?
Google or Other Web Search
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Parent First Name
Parent Last Name
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Street Address*
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Student First Name*
Student Last Name*
Student Email Address (Optional)
Is the student's address the same as the parent/guardian?
Yes - SKIP STUDENT ADDRESS
No
Student Address
Student Date of Birth*
Student's Current School (if applies)
Is there anything else you'd like us to know about you or your student?
Emergency Contact 1 (Not Immediate Family)*
Emergency Contact 1 Phone*
Emergency Contact 1 Email
Emergency Contact 2 (Not Immediate Family)*
Emergency Contact 2 Phone*
Emergency Contact 2 Email
I agree to the EPIC Percussion Student Media Release Agreement (access from link in fotter menu below).*
Please describe and allergies or restrictions the student may have.
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