Book AssessmentParent or Adult Student* First Name Last Name Student Full Name*Student Birthdate*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119202nd Student Full Name2nd Student BirthdateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Email* Phone*Name of Referring PersonHow did you find us?Internet SearchGoogle AdSchool NewsLocal SignageFriend ReferralMusic Teacher DirectoryFacebookTwitterKidspotYour ChildBubHubOtherYour SuburbYour ChoicePlease Select your InstrumentPianoGuitarViolinDrumsSingingFluteSaxophonePreferred LocationHave you Started Learning or Playing already?No. I have not had lesson or played beforeYes, but only teaching myself for a short timeYes, I have had lessons or been playing for more than 6 monthsDo you already have an instrument?No, I don't have an instrument, I want to have the trial to decide whether its right for me.No, I need help getting an instrumentYes, I have my own instrument to bring to the assessmentPlease select All the Selection that you are available to attend an assesment/trial.Monday Monday 12 - 3pm Monday 3 - 6pm Monday 6 - 8pmTuesday Tuesday 12 - 3pm Tuesday 3 - 6pm Tuesday 6 - 8pmWednesday Wednesday 12 - 3pm Wednesday 3 - 6pm Wednesday 6 - 8pmThursday Thursday 12 - 3pm Thursday 3 - 6pm Thursday 6 - 8pmFriday Friday 12 - 3pm Friday 3 - 6pm Friday 6 - 8pmSaturday Saturday 8 - 12pm Saturday 12 - 5pm Other TimeSubscribe to Our Newsletter I am happy to receive Wendy's Learn to Play Newsletter, as I know I can unsubscribe anytime.What will Happen Next?1. You will be sent an email form us asking you to confirm your email address. If it does not appearin in your inbox within a short period of time, please check your JUNK MAIL2. We will contact you by email with information about our teaching program and with the available assessment times that match your request as closely as possible.CommentsThis field is for validation purposes and should be left unchanged.