MCAA Private lesson | Millikin University

Student Registration Form for MCAA private lessons:

Parent/Legal Guardian Name

Parent/Guardian Email Address

Home Phone:

Cell Phone:

Work Phone:

Billing Information:

Billing Address:

Billing City:

Billing State:

Billing Zip Code:

Student Name:

Age:

Date of Birth:

Grade:

School:

Address (if different than Parent/Guardian)

Address

City:

State

Zip Code:

Do you currently take Private Lessons?

Yes

Private Teacher:

Program of Interest Private Lessons:

Instrument or Lesson Type:

Length of Lesson:

Number of lessons desired:

Instructor desired: rank choice between Faculty, Preparatory Faculty, MU Student Faculty: (1 being top choice, 3 being least:

Faculty:

Preparatory Faculty:

MU Student Faculty:

Other: (Allergies, concerns, etc):