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
Recommended by Instructor or Staff
Recommended by Another Student
Parent First Name
Parent Last Name
Parent Email Address
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
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.
Repeat Email Address
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