Private Lessons Registration Form *(denotes required field) Student's name: * Student's date of birth: * Parent's name: * Email address: * Home phone: * Cell phone: Mailing address Street address: * City, Province: * Postal code: * Day School and Grade (September 2014) Is there any information regarding special circumstances, allergies, or medical conditions that we should know about in order to help us teach your child to the best of our ability? Desired lesson duration: 30 min. 45 min. 1 hour Student's level: Beginner Intermediate Advanced Principal instructor: N/A Patricia Armstrong Jennifer Gray Domagoj Ivanovic Alla Shmaenok Thomas Evdokimoff Emily Chen Melina Ivanovic Preferred Lesson Day and Time: (e.g. Mondays at 3:30) Alternate Lesson Day and Time: (e.g. Tuesdays between 5 and 7) How did you hear about Arbutus Music Academy? N/A Friend Google Ad Internet Search engine Poster Flyer BC Parent Magazine Other Instrument of interest By clicking the "Submit" button, you acknowledge that you have read and agreed with the Studio Policy.