Private Lesson Registration Student Name: ________________________________________________

Instrument: _____________________________Phone Number: ___________________

NOTE: Lessons will be scheduled based on the availability of the teacher, number of students enrolled, practice room availability, and the student’s schedule. Every effort will be made to work out a schedule that works for BOTH the teacher and the student. PLEASE READ AND SIGN: I wish to enroll my son listed above in weekly private lessons and understand that the cost for lessons is determined by the private teacher plus any materials (music, method books, etc.) the teacher requests. Payment will be the responsibility of the student and made directly to the assigned lesson teacher. Private lesson teachers reserve the right to charge a student for missed lessons if no attempt was made to contact the teacher 24 hours prior to the lesson.

Parent Signature ________________________________________Date _____________

PLEASE RETURN THIS FORM AS SOON AS POSSIBLE TO: Austin O’Brien Saint Patrick High School 5900 W. Belmont Ave. Chicago, IL 60634

PRIVATE INSTRUCTORS: Scott Anderson: Trumpet, Piano Kenny Thompson: Guitar, Bass Rajiv Halim: Saxophone, Clarinet, Flute Mark Wozniczka: Trombone Mike Tooles: Drums/Percussion 5900 WEST BELMONT CHICAGO, IL 60634 PH 773.282.8844 FX 773.282.2361 WWW.STPATRICK.ORG [email protected]