Private Lesson Inquiry Form
Contact Information
Name of Parent Requesting Information: (only list the student’s name if he/she is over the age of 18)
First Name
Last Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Class and Goal
Please type Violin, Viola or Both Violin and Viola
Which class will the student be enrolled in?
What is the student’s level of playing?
Please Select
Beginner
Intermediate
Upper Intermediate
Advanced
What are the main goals of the student? (i.e. gaining entrance into an elementary, middle, high school or youth orchestra class, to have fun learning an instrument, to gain discipline)
Student Availability
Please list lesson day and time preferences (give at least 5 different days with times- i.e. Mondays from 4:30 pm to 5:00 pm, Thursdays from 6:00 pm to 7:00 pm- generally lessons will not be for over 1 hour)
Preference for Lesson Length
30 minutes
1 hour
Is the student interested in online lessons only?
Yes
No
Not at this time, but maybe in the future.
Optional: Post 60 second recording here:
These recordings will be used for placement and enrollment purposes only. Please make sure the recordings are labeled with the first initial and last name of the student, and the date the recording was taken. No videos please. (These recordings will not be used for any other purpose than for placement and enrollment purposes- Blessed and Beholden will not share the recordings with outside parties.)
File Upload
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Please verify that you are human
*
Submit
Should be Empty: