Ryckman Piano Registration

Easily apply for Music for Young Children classes, one-on-one private piano lessons, music camps, Ukulele Winters, or the Ukulele Summers program.

Name of Student*

First NameLast Name

Name of Parent/Guardian*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email*

example@example.com

6. Phone*

What would you like to register for?*

Private, one-on-one piano lessonsMusic for Young Children (ages 3-4)Music for Young Children (ages 5-6)Ukulele Summers (2025) Program (ages 4-12)Ukulele Summers (2025) Program (ages 13+)

8. Additional Comments/Questions? (Opt)

How can we help?

Photography/Video Consent and Social Media*

Yes, I consent to Ryckman Piano's use of my/my child's photograph, or video, to promote events, and to use as marketing on websites, social media posts, posters, or other.No, I do not consent to Ryckman Piano's use of my/my child's photograph, or video.

Policy Acknowledgement & Special Event Consent*

I understand and have read/signed Ryckman Piano's policies.I understand lesson fees, cancellation fees, and one-time fee policies.I understand where to go for lessons, and how to contact Ryckman Piano, if needed.I consent to my/my child's participation in special events associated with Ryckman Piano, such as recitals, Focus on Youth, Festival of the Arts, RCM Examinations, etc., understanding that these are optional (but recommended) community events.

12. Please sign & date this form.*

Today's Date*

Date