Private Lesson Request Form
Please fill out the below information, and I will get back to you regarding availability within a business week!
* Required
Your Name
*
Your answer
Are you the student, or the parent/guardian of the student?
*
Student
Parent/Guardian
If you are not the student, what is the student's name?
Your answer
How old is the student?
*
Your answer
What instrument/s do you/your student wish to learn?
*
Flute
Piano
Voice/Singing
Other:
Required
What is the best way to contact you?
*
Email
Phone
Social Media
Other:
Required
Please provide your phone number/email/social media handle here:
*
Your answer
What time/s is your first choice for a weekly lesson meeting?
*
Choose
Mondays at 4:30pm
Mondays at 5:00pm
Mondays at 5:30pm
Mondays at 6:00pm
Tuesdays at 4:00pm
Tuesdays at 4:30pm
Tuesdays at 5:00pm
Tuesdays at 5:30pm
Tuesdays at 6:00pm
Wednesdays at 4:00pm
Wednesdays at 4:30pm
Wednesdays at 5:00pm
Wednesdays at 5:30pm
Wednesdays at 6:00pm
Thursdays at 4:00pm
Thursdays at 4:30pm
Thursdays at 5:00pm
Thursdays at 5:30pm
Other
List your second and third choices from above.
*
Your answer
Any other questions or concerns?
Your answer
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