WELLINGTON STREET PLAZA
68 WELLINGTON STREET
PORT HOPE, ON. CANADA
L1A 4H7
905•885•2467
lorne@dontfretguitarinstruction.com
.Student Registration Questionnaire
Student’s name _____________________________________________
Instrument(s)
(Please check all that apply)
o Electric guitar
o Acoustic guitar
o Electric bass guitar
Students Current Level
o Absolute beginner
o Beginner with some experience
o Intermediate
o Advanced
Students Main Musical Interest(s)
(Please check all that apply)
o Classic Rock (AC/DC, Pink Floyd, Eagles, etc.)
o New Rock (Fall Out Boy, Billy Talent, City And Colour, etc.)
o Pop (Miley Cyrus, Vanessa Carlton, etc.)
o Metal (Metallica, Black Sabbath, Megadeth, etc.)
o Punk (Sum 41, Ramones, Green Day, etc.)
o Country (Taylor Swift, Carrie Underwood, Brad Paisley, etc.)
o Blues (Stevie Ray Vaughn, Eric Clapton, B.B. king, etc.)
o Jazz (Joe Pass, George Benson, Herb Ellis, etc.)
Reason(s) For Learning An Instrument
(Please check all that apply)
o Fun and relaxation
o Learn to read music
o Play in a band situation
o Serious study
o Very serious study and dedication