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If you're the student's parent/guardian, what is your first name?
If you're the student's parent/guardian, what is your last name?
What is the student's first name? *
What is the student's last name? *
What is the student's age? *
What instrument(s) does the student play?
 *
Required
What is the student's preferred instrument?
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If it allows for their faster band placement, is the student willing to play a different instrument? 
Clear selection
What's a good email address to reach you? *
What's a good phone number to reach you? *
Who is the student's current music teacher for one-on-one lessons?
Which weekdays is the student available for? 
(Note: Please select one check box for the entire hour desired, as each check box represents a 60 minute period)
Mon
Tue
Wed
Thur
Fri
5:00 PM
5:30 PM
6:00 PM
6:30 PM
7:00 PM
7:30 PM
8:00 PM
8:30 PM
9:00 PM
Which weekend days is the student available for?
(Note: Please select one check box for the entire hour desired, as each check box represents a 60 minute period)
Sat
Sun
10:00 AM
10:30 AM
11:00 AM
11:30 AM
12:00 PM
12:30 PM
1:00 PM
1:30 PM
2:00 PM
2:30 PM
3:00 PM
3:30 PM
4:00 PM
4:30 PM
5:00 PM
5:30 PM
6:00 PM
6:30 PM
7:00 PM
7:30 PM
8:00 PM
8:30 PM
9:00 PM
Do you have any notes for us regarding the student's availability?
Submit
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