Private Lesson Inquiry Form

Please contact Student/Faculty Liaison Jessica Wilcox at 781-749-7565, ext. 37 or
Duxbury Campus Manager Nancy Meredith at at 781-934-2731 x11 for assistance.

You may also Download a PDF of our Private Lesson Inquiry Form to email or mail to us.

How did you learn about SSC's private lesson program? (check all that apply)*
Student Name:*

Student's Date Of Birth or "adult"*

Parent/Guardian's First Name (type "adult" if you are an adult)*

Primary Phone:*


Secondary Phone:*


School and grade (if applicable):*

Emergency Contact's Name*

Emergency Contact's Phone*


What instrument are you interested in studying? (voice included)*

Campus: (check one or both)*
Previous experience on instrument:
Other musical experience: (choir/band/orchestra etc)
Other interests
What kind of teaching style do you think will work for you/your child?
What are the goals/ambitions of the student?
Is there anything else you think we should know in order to effectively place this student?
Please check off available days *
What would be the earliest time you could start a lesson on your available days?*

What would be the latest time you could start a lesson on your available days?*

May we have permission to use photographs of you or your child for promotional purposes? *
How did you hear about South Shore Conservatory?*

Word Verification: