Private Instrumental Music Tuition

Student First Name *

Student Last Name *

Year Level: *

** Not available in Group lessons

Preferred lesson mode: *

30 minute individual45 minute individual1 hour individualGroup

Do you require the Hire of Instrument? Fees are $150 per semester** *

YesNo

** Not available for Drum Kits, Keyboards or Pianos

Parent/Guardian Information:

Parent/Guardian Full Name *

Contact Number *

Email Address *

Parent/Guardian signature *

Draw signature|Type signatureClear

I have carefully read and understood the terms and conditions relating to the Private Instrumental Tuition Program and agree to meet those conditions.

Signed Date *

If you have any queries, please call Director of Music, Mr John Collins on 9845 3310 or email Mrs Brittany Stock at bstock@emmaus.vic.edu.au