TO BE COMPLETED BY THE STUDENT OR ON THEIR BEHALF BY THEIR PARENT OR GUARDIAN
(for students under 18 years)
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I. PERSONAL DETAILS:
Title (Mr / Mrs / Miss / Ms / Other): _________________________________________
Surname: ______________________________________________________________________
First Name(s): ________________________________________________________________
Home Address: ________________________________________________________________
________________________________________________________________
________________________________________________________________
Telephone (home / evening): _________________________________________________
Telephone (daytime / mobile): _________________________________________________
E-Mail (if applicable) : _________________________________________________
Date of Birth: ________________________________________________________________
Nationality: ________________________________________________________________
Name and Address of Parent or Guardian (for students under 18 years):
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
Telephone: _____________________________________________________
Music School(s) or Colleges Attended (if applicable):
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Please list qualifications obtained or any other experience you have gained
that you feel are relevant to your application:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
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II. I WISH TO ENROL FOR THE FOLLOWING COURSES
(please tick your options in the checkboxes on the left):
[ ] INDIVIDUAL TUITION
[ ] FLUENT SIGHT-READING
[ ] Programme: QUICK MASTERING
[ ] Course: HOW TO TRANSFORM YOUR HANDS: REACH OUT AND GET WHAT YOU WANT
[ ] Programme: THE ESSENCE OF SOUND
[ ] ENSEMBLE WORKSHOPS
____________________________________________________________________
I declare that to the best of my knowledge the statements I have made on this
form are correct.
Signature: ____________________________________________________________________
Date : ____________________________________________________________________
We will contact you by letter within the next 10 working days to arrange a
consultation lesson.
PRIVACY GUARANTEE:
All information provided on this form will be treated as confidential and will
not be passed on to any third parties.
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III. QUESTIONNAIRE
The following questions are not compulsory but will help us to assess your
musical needs and assist GéNIA MUSIC in continuing to provide a focused,
professional and innovative approach to music education. All information
provided by you will be treated as strictly confidential.
Relax... There are no tricky questions!!!
1. Which newspapers / magazines do you regularly read?
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
2. How do you usually find out about music courses, events and releases?
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
3. What are your main areas of interest outside music?
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
4. Which styles of music do you regularly listen to?
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
5. Are there any artists or performers you particularly like?
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
6. If you have attended a music course in the past, what was the strongest and
weakest aspect of that college or course?
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
7. What are your ambitions as a practical musician?
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
8. When you learn, how do you remember information --- i.e. how would you
describe your memory type (E.g.: photographic, symbolic, literary, aural)?
Please elaborate:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
9. Please indicate how much performance experience you have
[ ] very experienced
[ ] no experience
[ ] other (please specify): ________________________________________________
________________________________________________
________________________________________________
10. Would you be interested in further seminars or exercises which deal with
performance problems and/or injuries?
[ ] YES -- performance problems
[ ] YES -- performance injuries
11. Would you like to receive further information about GéNIA's new releases
and/or concert dates?
[ ] YES
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IV. WHAT TO DO NOW:
Please email us or bring a completed and signed application form and questionnaire (optional)
with you to the first session.
For information on prices or any other questions please call us on:
(020) 7226 9829 (within the U.K.)
+44 (20) 7226 9829 (international)
or e-mail us on info@genia-music.com