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Simpli Music Lesson Application
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* Indicates required question
Email
*
Your email
Parent/Caregiver Name (main point of contact) (more than one name may be provided)
*
Your answer
Mobile Phone Number (main point of contact) (more than one name may be provided)
*
Your answer
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)
*
Your answer
Instrument/Class of choice (check all that apply)
*
Violin
Viola
Piano/Keyboard
Church Band
Required
Does your child have their own instrument? In some cases, rentals are available so consult the director.
*
Yes
No
Please provide the best mailing address. (for billing purposes and for mailing sheet music if necessary)
*
Your answer
Does your child have headphones, earphones, earbuds or a headset? (check one)
*
Yes
Will have it before lessons begin
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.
*
Yes
Will have it before lessons begin
Does your child have a metronome? (check one) If you are unsure, more information will be provided at the consultation.
*
Yes
Will have it before lessons begin
N/A for theory class
Select your invoice setup (choose one).
Send full payment
Two installments
Clear selection
Finally, will you be able to ensure your child has a dedicated practice and lesson space?
*
Yes
Will have it before lessons begin
I understand that this is a fee based music service and payment will be required. Installment plans are available.
*
Yes
Required
I hereby give permission for Music to use my child's performances or picture with first name and last initial on company sites and marketing materials.
*
Yes
No
No pictures; permission for projects, writing and art work
Required
Do you have anything else to share about your child's learning style or learning concerns with the Director?
Your answer
Send me a copy of my responses.
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