Semi-Private Lesson Inquiry Form
Please complete the form below to request semi-private lessons for the Winter/Spring session, January through June 2019. When we receive your form we will contact you to arrange lessons. An invoice will follow once lessons are scheduled.
Email address *
Student First Name *
Your answer
Student Last Name *
Your answer
Date of Birth *
Your answer
Gender
What school does your child attend? *
Your answer
Grade *
What instrument would you like to study? *
If you would like to request to work with a particular student please indicate student's name here. If you would like IMSCC to assign a partner for your child please indicate that here. *
Your answer
Is this your first or second year playing your instrument? *
Please indicate first and second choice of lesson day and time *
Your answer
Desired lesson length? *
Special learning needs or health considerations?
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Parent 1 Name *
Your answer
Parent 1 primary phone number *
Your answer
Is this number...? *
Parent 1 secondary phone number
Your answer
Is this number...?
Parent 1 Email *
Your answer
Parent 2 Name
Your answer
Parent 2 primary phone number
Your answer
Is this number...?
Parent 2 secondary phone number
Your answer
Is this number...?
Parent 2 Email
Your answer
Student Cell if applicable
Your answer
Student Email if applicable
Your answer
Submit
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