Language
English (US)
Debra Readman Piano Studio
www.DebraReadmanPianoStudio.com
Private Piano Lessons Registration
September 12, 2022 - June 12, 2023
Who is registering for lessons?
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I'm registering my child
I'm an Adult student
Are you a returning student, or new to the piano studio?
I'm a returning student
I'm a new student
Are you a beginner (or your child if registering for a child), or have you taken lessons in the past? Please share here if you are new to piano lessons, or if you've taken lessons in the past, how long ago and for how long did you take lessons? This helps me plan ahead for your first visit. :)
Student Name
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First Name
Last Name
Student's Date of Birth
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Student Email
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example@example.com
Mobile Phone
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Home Phone
Home Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Parent/Guardian name
*
First Name
Last Name
Relationship to student (eg. parent, grandparent)
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Parent/Guardian Mobile
*
Parent/Guardian Email
*
example@example.com
Parent/Guardian #2 Name
First Name
Last Name
Relationship to student (eg. parent, grandparent)
Parent/Guardian #2 Mobile
Parent/Guardian #2 Email
example@example.com
How do you prefer to receive communication, including automatic lesson reminders?
*
Email
Text
Both Email and Text
I am registering for
*
In-Studio lessons (note: lessons may be switched to Live Video if government restrictions are imposed). You may also switch to Live Video lessons at any time.
Live Video lessons (note: you may switch to In-Studio lessons at any time)
Lesson Duration
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30 minutes
45 minutes
60 minutes
I would prefer the following tuition payment schedule:
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1 payment (due Sept. 1)
3 payments (Sept. 1, Dec. 1, Mar. 1)
10 payments (1st of each month from Sept. - June)
A payment schedule will be included in an email you will receive confirming September time slots. An invoice will only be sent to you as a reminder if payment is not received by the 3rd of the month. However, if you prefer you can request invoices to be sent on the 1st for each month there is a payment due (depending on your chosen payment schedule).
*
I would like an invoice on the 1st of the month if there is a payment due
I would prefer not to have invoices sent unless I have forgotten payment
Are there any personal circumstances I should be aware of such as learning disabilities, special needs, allergies (including food) or other health issues?
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Yes
No
If yes, please type a confidential explanation here for the above question:
*
Would you like to keep your current time slot (from June 2022) or will you be needing a change?
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I would like to keep my time slot if possible (please indicate your regular time slot when answering the next question)
I would like a different day and/or time
What days and times will work for you for lessons? Please indicate your available times for each day. (ie: Mondays after 3:00 pm, Tuesdays before 5:30 pm, Wednesdays n/a, etc.)
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Occasionally piano games may include small treats such as mini marshmallows or M&Ms for a game or activity. Piano packets in September, student prizes or gifts may include a candy item or homemade baked treats, etc. Please type Yes, No, or a longer message to let me know if this is okay with you.
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Treats okay? Please indicate Yes or No
Any other comments or notes?
How did you hear about my piano studio?
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A friend or family member
Google Search
Facebook
(other, please indicate)
PLEASE READ the document linked below as I adjust the Studio Policies and Tuition Rates every year.
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