Simpli Music Lesson Application
Email *
Parent/Caregiver Name (main point of contact) (more than one name may be provided) *
Mobile Phone Number (main point of contact) (more than one name may be provided) *
Student Full Names (write the names of all students interested and their instrument experience. Example: Vivian Wells, one year of recorder and clarinet at school) *
Instrument/Class of choice (check all that apply) *
Required
Does your child have their own instrument? In some cases, rentals are available so consult the director. *
Please provide the best mailing address. (for billing purposes and for mailing sheet music if necessary) *
Does your child have headphones, earphones, earbuds or a headset? (check one) *
Does your child have a music stand? (check one) If you are unsure of what this is, more information will be provided at the consultation. *
Does your child have a metronome? (check one) If you are unsure, more information will be provided at the consultation. *
Select your invoice setup (choose one).
Clear selection
Each child must have their own technology. Does your child have access to a desktop, iPad, tablet or laptop with speaker/microphone and camera? (The zoom interface and our ability to share music works best with these devices only. Phones are not an option.) *
Required
Finally, will you be able to ensure your child has a dedicated practice and lesson space? *
I understand that this is a fee based music service and payment will be required. Installment plans are available. *
Required
I hereby give permission for Music / Tutoring to use my child's performances or picture with first name and last initial on company sites and marketing materials. *
Required
Do you have anything else to share about your child's learning style or learning concerns with the Director?
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