2023 Summer Registration Form
Palmer Piano Studio
Parent #1
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent #2
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Who should I contact first when needed?
*
Parent #1
Parent #2
Contact Student(s) Directly
Our family will...
*
Pay in full by June 15, 2023
Pay 1/2 by June 15, 2023 and balance by July 15, 2023
Pay weekly, at or prior to each lesson
Student #1
Name
*
First Name
Last Name
Phone Number
Please enter a valid phone number if you wish for me to communicate with your student directly.
This student is...
*
A returning student to Palmer Piano Studio
A new student to Palmer Piano Studio who has taken piano lessons before
A new student to Palmer Piano Studio who has not taken piano lessons before
Lesson Length
*
30 minutes, minimum of 6 throughout summer 2023 ($28/lesson)
45 minutes, minimum of 4 throughout summer 2023 ($42/lesson)
Does this student intend to take more lessons than the minimum this summer?
*
Yes
No
Maybe
What Piano "Ticket(s)" is this student choosing? Please check all that interest this student.
*
Custom Piano Lessons
Ensembles (Duets, Trios, etc.)
Piano Music From Around the World
MMTF Recital Prep
BAMTA Festival Prep
Your Choice
If you selected "Your Choice" above, please explain here:
What types of music interest this student? Please check all that apply.
*
Jazz/Rags/Blues
Country
Movie/Musical/Video Game
Classical
Patriotic
Sacred
Pop/Rock
Student #2 (If Applicable)
Name
First Name
Last Name
Phone Number
Please enter a valid phone number if you wish for me to communicate with your student directly.
This student is...
A returning student to Palmer Piano Studio
A new student to Palmer Piano Studio who has taken piano lessons before
A new student to Palmer Piano Studio who has not taken piano lessons before
Lesson Length
30 minutes, minimum of 6 throughout summer 2023 ($28/lesson)
45 minutes, minimum of 4 throughout summer 2023 ($42/lesson)
Does this student intend to take more lessons than the minimum this summer?
Yes
No
Maybe
What Piano "Ticket(s)" is this student choosing? Please check all that interest this student.
Custom Piano Lessons
Ensembles (Duets, Trios, etc.)
Piano Music From Around the World
MMTF Recital Prep
BAMTA Festival Prep
Your Choice
If you selected "Your Choice" above, please explain here:
What types of music interest this student? Please check all that apply.
Jazz/Rags/Blues
Country
Movie/Musical/Video Game
Classical
Patriotic
Sacred
Pop/Rock
Student #3 (If Applicable)
Name
First Name
Last Name
Phone Number
Please enter a valid phone number if you wish for me to communicate with your student directly.
This student is...
A returning student to Palmer Piano Studio
A new student to Palmer Piano Studio who has taken piano lessons before
A new student to Palmer Piano Studio who has not taken piano lessons before
Lesson Length
30 minutes, minimum of 6 throughout summer 2023 ($28/lesson)
45 minutes, minimum of 4 throughout summer 2023 ($42/lesson)
Does this student intend to take more lessons than the minimum this summer?
Yes
No
Maybe
What Piano "Ticket(s)" is this student choosing? Please check all that interest this student.
Custom Piano Lessons
Ensembles (Duets, Trios, etc.)
Piano Music From Around the World
MMTF Recital Prep
BAMTA Festival Prep
Your Choice
If you selected "Your Choice" above, please explain here:
What types of music interest this student? Please check all that apply.
Jazz/Rags/Blues
Country
Movie/Musical/Video Game
Classical
Patriotic
Sacred
Pop/Rock
Submit
Should be Empty: