Registration
Lesson Package
Parent/Adult Student Name
*
First Name
Last Name
Student Name (if under 18)
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Parent/Adult Student Email:
*
example@example.com
Which best describes the student?
*
child/pre-college, has never taken piano lessons
child/pre-college, has studied piano
adult, has never taken piano lessons
adult, has studied piano
Please describe the student's prior experience with music or piano, if any.
Do you have a piano or keyboard at home?
*
yes, an acoustic piano (not electronic)
yes, a full-size digital piano (88 keys)
yes, a small keyboard (fewer than 88 keys)
no piano or keyboard
Please indicate your preferred lesson times for Monday through Sunday.
*
Payment
*
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( X )
Six 45-minute Private Lessons
$
420.00
lesson fee
Book Fee
$
30.00
book fee
Enter coupon
Apply
Total
$
0.00
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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