Music for the Holidays Submission Form

Faculty Member's Name: *

Student's Name: *

Instrument: *

Student's Level: *

Student's Age: *

Lesson Day: *

Lesson Time: *

:

am

pm

Additional Performers and Their Instruments:

Such as duet, trio, quartet. Be sure to include every additional performer's name and instrument.

Concert Date/Time: 1st Choice : *

Concert Date/Time: 2nd Choice : *

Does this performer need to be placed on the same concert as a sibling?: *

Yes

No

If yes, what is the sibling's name?:

Piece 1 Title: *

Piece 1 Composer: *

Piece 1 Length: *

Total Length of Performance: *

This must not exceed 8 minutes.

Piano stool needed (to elevate student's feet): *

Yes

No

Amp needed: *

Yes

No

Microphone needed: *

Yes

No

PA and speakers needed: *

Yes

No

Does the student need a Powers piano accompanist?: *

Yes

No

If yes, a piano accompanist will contact the student to set up a rehearsal.

Parent contact name:

Parent's email address: *

Parent phone number (best one):

Phone number is:

Cell

Home

Work

I understand I must submit the piano part within 3 days of this form or my student will not have time reserved. : *

Yes

N/A

I will drop off the accompaniment music at Powers office on (specify date):

Faculty member's email address: *

Terms of Agreement: *

I agree

I understand that my submission is final and that I cannot change the proposed program. I understand that I am responsible for confirming the recital time and etiquette with my student, and will discuss these things during our upcoming lessons.