NEW STUDENT INQUIRY FORM
Upper Valley Music Center
Who are you inquiring for?
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Myself
My child/children
Other
What program are you interested in?
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Individual Lesson Program
Suzuki Program
Group Classes
Not sure, I'd like to learn more
Please select your instrument
Which instrument would you like to study with us?
Guitar
Ukulele
Piano
Voice
Percussion
Fiddle
Harp
Winds
Flute
Clarinet
Saxophone
Bassoon
Brass
Trombone
Trumpet
Tuba
Baritone/Euphonium
French Horn
Traditional Strings
Violin
Viola
Cello
Suzuki Strings
Violin
Viola
Cello
Other
Which classes are you interested in?
Why are you interested in individual lessons or group classes? Do you have any past musical experience that you would like us to know about?
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Do you have any special needs that you would like us to know about, or is there anything UVMC can do to help you access our programs?
When would you like to start?
As soon as possible
The beginning of the next term
During the summer
Other
Time Preference: What time is the student available to take lesson during the academic year?
Daytime until 3 pm (weekdays)
Afternoons, 3 - 6 pm (weekdays)
Evenings after 6 pm (weekdays)
Weekends
Other
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Name of Student 1
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First Name
Last Name
Date of Birth of Student 1
*
Pronouns of Student 1
Name of Student 2 (If Applicable)
First Name
Last Name
Date of Birth of Student 2 (If Applicable)
Pronouns of Student 2 (If Applicable)
Name of Parent/Legal Guardian (If Applicable)
Phone Number
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-
Area Code
Phone Number
Email
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example@example.com
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Where did you hear about UVMC?
Word of mouth (friend, family member, or coworker)
Social media
Internet search
Postcard
Print advertisement
Poster/flier
Other
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