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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
Please Check One That Applies
# 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
Home
About the Instructor
>
Booking
About Nia Strings
What is Kwanzaa?
Lessons, Benefits & Resources
In Home Lessons
Liberated Minds Home School Academy
Magnolia Blossom Montessori
>
Magnolia Group Class Updates & Announcements Page
>
Student Resources & At Home Practice Page
Mizizi Home School Co-op
>
Tribe Links, Updates & Announcements
>
Student Resource Page
(Instructors Only Page)
Inquiries
Student Registration/Sign Up
Online Payment (s)
Contact Me
Gallery
Inspirational Black Violinists & Composers
Shows & Events
>
Fall Recital 2012
NSL Newsletter/ Blog