PRIVATE Instruction Request Form Name * First Name Last Name Email Address * Phone (###) ### #### Date of Birth What are you hoping to gain from Private Instruction? * What is your availability (days of the week & times)? * Do you have any health issues? Are you experiencing pain? Please explain briefly. * We recommend letting us propose a teacher who will best suit your needs, but if you have a teacher preference please do let us know in the box below and we'll accommodate your request if possible. Do you have any questions or additional comments? Thank you! Our Individual Instruction Coordinator will contact you soon.
