Suzuki Placement Form

Student Information

Thank you for your interest in the Suzuki program at MacPhail Center for Music! To help us place your child with a teacher, please complete and submit the following form.

1. Please provide your contact information.

Student First Name *This question is required.

Student Last Name *This question is required.

Student's Date of Birth *This question is required.

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Student's Preferred Pronouns and/or Gender

Parent First Name

Parent Last Name

Street Address *This question is required.

Apt/Suite/Office

City *This question is required.

State *This question is required.

Zip Code *This question is required.

Email Address *This question is required.

Preferred Contact Number *This question is required.

Contact Number 2

Contact Number 3

2. At which site do you want to have your lessons? *This question is required.

3. When would you like to begin lessons? *This question is required.

Please enter an 'other' value for this selection.