1:1 Music Program Interest Form (In-person)
FCSN’s 1:1 Music Program is intended to be for new music learners, teaching basic technique and concepts. It is an introductory program to help parents determine whether music is a passion for their child. Think of it as a launch pad into the world of music! 

It is important to note that this program is not intended to advance students to the next musical level; however, through participation in this program, we hope your student is able to determine whether they would like to seriously pursue music elsewhere.

Who: Children and adults with special needs who are interested

When: Monday to Friday 3-6PM, Saturday to Sunday 1-6PM  (depending on room availability) 
    - Once a week for 30 min. or 45 min./session   
    - 12 lessons + 1 free trial lesson for new students

Where: FCSN Fremont Center (2300 Peralta Blvd., Fremont, CA 94536)

Cost:
    - In-person $120/12 lessons (30 min/session)
    - In-person $180/12 lessons (45 min/session)


This program is for FCSN members only (To become a member, click http://fcsn1996.org/become-a-member/)

Contact: Jennifer Chu for schedule availability and questions: (eb.enrichment@fcsn1996.org)

**We will contact you once we find the instructor who matches your requirement and availability.  The music program is in high demand and is dependent on music tutors and matching participants' schedules along with room and instrument availability.  If there is no match, you will be on the waitlist.

Parent or guardian is required to stay with the student during the lesson.

Any absences without a 24 hour notification to the instructor will count as a paid lesson. Two unpaid lessons will result on a freeze on your student’s music lessons.
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Email *
Please specify the instrument *
We have piano and keyboard at our center. For violin, student should bring their own instrument to the center.
Required
Preferred session *
Student’s Name: *
Gender *
Date of Birth *
MM
/
DD
/
YYYY
Student's age *
Diagnosis *
Student's address *
Guardian's Name *
Guardian's Phone Number *
Guardian's Email *
Favorite Type of Music *
Required
Has student studied music before? *
If yes, how long?
Has the student played an instrument before? *
If yes, what instrument(s)?
Time/Date availability? *
In-person: Weekdays from 3-6PM, Weekends 1-6PM (depends on room availability)
Any other questions, concerns, or instructor requirement (Optional)
I give my permission to Friends of Children with Special Needs (FCSN) staff to film, photo, or tape my family for the purpose of promoting the objectives of this music program. *
Payment Information
A new coming student will get 1 FREE TRIAL LESSON. You will pay after the trial lesson and the payment is due at the 1st official lesson.

COST:
    - In-person  $120/12 lessons (30 min/session)
    - In-person  $180/12 lessons (45 min/session)
    - Online: Please visit https://sntutoring.org to sign up for SNTutoring

This program is  for FCSN members only. Joining FCSN membership is as easy as filling out an application form and paying a one-time / life-time membership fee for $50 for your entire family.
(http://fcsn1996.org/become-a-member/)

Please make check payable to “FCSN” with " Student’s name, 1:1 Music Program" in the memo line.  
Please send or drop it off at our center (2300 Peralta Blvd., Fremont CA  94536).
Thank you for the registration. A program coordinator will contact you once we find the instructor who matches your requirement and availability.

For more information, please contact Jennifer Chu
eb.enrichment@fcsn1996.org l 510-739-6900 ex 3312
A copy of your responses will be emailed to the address you provided.
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