INQUIRY FORM

 


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* Student First Name:
* Student Last Name:
* Address 1:
Address 2:
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* Phone:
Fax:
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* Student's age:
Parent/Guardian Name 1:
Parent/Guardian Name 2:

Responsible Party Information
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Alt Phone:
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*How did you hear about the Music Conservatory of Westchester? (check all that apply)
Flyer/Brochure in Mail Word of Mouth Attended an Event
Flyer/Brochure at community location ArtsWestchester Library
Catalog in community location Internet Search Phone Book
Scarsdale Inquirer Journal News WQXR Radio Ad
Print Ad (Please Specify in Other) 107.1 The Peak Radio My School or Teacher
Internet Ad or Facebook Page Current Student/Family Other:

*Area of Interest
Instrument:
Voice (ages 12+)
Musicianship Class:
Early Childhood:
Musical Theatre
 
Music Therapy
Ensembles:
Summer Programs
Other (If Music Therapy student please identify area of need):
Not Sure

*Please tell us your preferred days and time frames for instruction.
MONDAY
9am-12pm
12pm-3pm
3pm-6pm
6pm-9pm
TUESDAY
9am-12pm
12pm-3pm
3pm-6pm
6pm-9pm
WEDNESDAY
9am-12pm
12pm-3pm
3pm-6pm
6pm-9pm
THURSDAY
9am-12pm
12pm-3pm
3pm-6pm
6pm-9pm
FRIDAY
9am-12pm
12pm-3pm
3pm-6pm
6pm-9pm
SATURDAY
8:30am-11am
11am-2pm
2pm-5:30pm


*After you submit this inquiry form, the Registrar will contact you to continue the process.

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Early Childhood
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