2024 Fall Semester Registration Form
Thank you for registering for lessons with Exit 1 Piano Lessons! The 2024 Fall Semester will begin August 11, 2024 and end December 14, 2024. Please see our website calendar for a full list of important dates for the 2024 Fall Semester. You can choose between 30, 45, or 60 minute weekly lessons for the 2024 Fall Semester. Don't forget to fill out a separate form for each student and for each instrument! We look forward to seeing you soon!
Student Information
Student Name
*
First Name
Last Name
Student Age
*
Please Select
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Adult
Years of Experience
*
Please Select
0
1
2
3
4
5+
Is there anything else you would like the instructor to know about the student?
Lesson Type and Length
Choose your instrument and length of lessons. You can also indicate your instructor preference if desired.
For which instrument would you like to register?
*
Piano
Voice
Guitar
Violin
Saxophone
Trumpet
Trombone
Songwriting/Composing
Please select your lesson length below:
*
30 Minutes
45 Minutes
60 Minutes
Preferred Instructor
Please Select
NO PREFERENCE
Clair Susong
Bryant Mullins
Stacy Beyer
Ariadna Benítez
Ashantia Mitchell
Daniel Ferguson
Betsy Adair
Savanna Watson
Jed Edmondson
Emily Sholar
Contact Information
Parent or Guardian Name (Adults put N/A):
*
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Media Release
*
I give my permission for mine or my child's likeness in images or videos to be used on the Exit 1 Piano Lesson website and social media page(s) or in advertisements.
I do NOT give my permission for mine or my child's likeness in images or videos to be used on the Exit 1 Piano Lesson website and social media page(s) or in advertisements.
By submitting your registration form, you are agreeing to abide by the Policies and Procedures found on our website: exit1pianolessons.com. Please check the box below to indicate that you have read and understand the Policies and Procedures.
*
I agree to abide by the Policies and Procedures during the 2024 Fall Semester.
Signature
Payment
All payments for the monthly payment plan are due on the 15th of the month (September 15th, October 15th, and November 15th). The first payment is due now at the time of registration. You can also choose to pay the entire tuition at the time of registration. All prices below also include the $10 registration fee.
My Products
*
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Monthly Payments, 30 Minute Lessons
$
120.00
Monthly Payments, 45 Minute Lessons
$
175.00
Monthly Payments, 60 Minute Lessons
$
230.00
Full Semester, 30 Minute Lessons
$
450.00
Full Semester, 45 Minute Lessons
$
670.00
Full Semester, 60 Minute Lessons
$
890.00
Credit Card
Submit
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