Student Registration/Sign Up

NIA STRINGS
Private and group
REGISTRATION Form

Student Information:

* Indicates required field

Student Name *

Student Date of Birth *

Parent Information:

Adult, Parent/Gardian #1 Name *

Adult, Parent/Gardian #1 Phone Number *

Adult, Parent/Gardian #1 Email *

Parent/Gardian #2 Name (or NA) *

Parent/Gardian #2 Phone Number (or NA) *

Parent/Gardian #2 Email (or NA) *

Students Primary Address (City, State, Zip) *

Students Secondary Address (City, State, Zip, NA) *

skill level:

Skill Level *

Red "Himba Namibia" Beginner ..... (early beginner = 0 knowledge, to late beginner = basic knowledge) Black "Zulu" Intermediate I (basic knowledge, can recall with little difficulty) Green "Masai" Intermediate II ( more than basic knowledge, can recall with no difficulty) Yellow "Yoruba" The Womb/Prenatal Group

# Of Years Played (If none write NA) *

length of lesson:

Length Of Lesson Time Requested *

15 - 30 minutes 1 hour 1 - 1/2 hour

time/day preference:

Please Note - That some of the times listed above are 15 minute time slots, and some are for 30 minutes. If you wish to have a time slot that is not listed, please indicate in the box to the right what day/time you prefer. Nia Strings Violin Instructor will try and accommodate different times if possible.

Write in Day Preference (chose from slots provided at the top of this form) *

What Date Would You Like to Start? *

ADDITIONAL COMMENTS:

Please write any additional comments you wish for the instructor to know about the student *

Submit Form