HIGH NOTES MUSIC PROGRAM
Application form
Full Name of applicant
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First Name
Last Name
Current Age
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Street Address
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City, Province, Postal Code
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E-mail
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Phone Number: Best one to contact you
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Area Code
Phone Number
Have you been touched by mental illness?
No
Yes
I think so
Main reason for applying
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Choose all that apply to you:
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I already know how to play an instrument
I have never taken instrumental music instruction before
I have a piano or keyboard that I can practise on
I have a guitar that I can practise on
I have a clarinet that I can practise on
I have a saxophone that I can practise on
I already have a harp that I can practise on
I prefer to learn to play the piano
I prefer to learn to play the clarinet
I prefer to learn to play guitar
I prefer to learn to play saxophone
I prefer to learn to play the harp
I know how to read music
I prefer to take part in a group music session
I am more interested in classical music
I am more interested in current music
If accepted, I would like to be considered for a subsidized instrument
If accepted I am committed to attending my weekly lessons and will give at least 24 hours notice if unable to attend my lesson as scheduled.
I understand that the registered charity HIGH NOTES AVANTE is paying for the lesson fees, material and rent and will still have these expenses if I don't communicate my absence in advance. Therefore, they can discontinue the lessons if they find I am not being respectful
PLEASE INDICATE YOUR FIRST CHOICE CLASS:
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Do you want an in-person individual music lesson?
Yes
No
Please tell us your closest major intersection and city
What is your availability (for a 30 minute music lesson)?
I am flexible and will take whatever slot I get
Weekday mornings
Weekday evenings
Mondays 6-9:00 pm
Wednesdays 6-9:00 pm (afternoons/evening)
Saturdays 10:00 am-1:00 pm
Saturdays 1:00-4:00 pm
Other possibilities:_____________________________________________
I would prefer an online lesson
Additional information to support your application to the program:
Optional Reference
Could be anyone who can vouch that participating will benefit you.
Reference #1 Name, Phone, Email & Relationship to you
Thank you for applying to High Notes Music Program
We are so excited to meet you and will be in touch as soon as possible.
Date
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Month
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Day
Year
Date
Submit
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