Melia Music - Intake Form

Intake Form - PAYG

First Name*

Last Name*

Primary Email*

Primary Phone*

Alternative Phone Number

Associated School (if applicable)

Please choose below from ‘Private’ (at my music room in Didcot) or ‘In-school’ (if I currently teach at your school). Please only select 'school' if I have an existing contract with the school in question.

Private or In-School Lessons?