Registration for Piano Lessons Debra Readman

Debra Readman Piano Studio

www.DebraReadmanPianoStudio.com
Private Piano Lessons Registration

September 12, 2022 - June 12, 2023
Who is registering for lessons?*

I'm registering my childI'm an Adult student
Are you a returning student, or new to the piano studio?

I'm a returning studentI'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*

First NameLast Name
Student's Date of Birth*
Student Email*
example@example.com
Mobile Phone*
Home Phone
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent/Guardian name*

First NameLast Name
Relationship to student (eg. parent, grandparent)*
Parent/Guardian Mobile*
Parent/Guardian Email*
example@example.com
Parent/Guardian #2 Name

First NameLast 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?*

EmailTextBoth 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*

30 minutes45 minutes60 minutes
I would prefer the following tuition payment schedule:*

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 dueI 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?*

YesNo
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?*

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.)*
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.*
Treats okay? Please indicate Yes or No
Any other comments or notes?
How did you hear about my piano studio?*

A friend or family memberGoogle SearchFacebook(other, please indicate)
PLEASE READ the document linked below as I adjust the Studio Policies and Tuition Rates every year.*
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Debra Readman Piano Studio

Private Piano Lessons Registration