Piano Class Registration

Piano Lessons Registration Form
Name

First NameLast Name
Date of birth

MonthDayYear
Date
Gender

MaleFemale
Parent/Guardian Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Name

First NameLast Name
Relationship to Student
Phone Number
Please enter a valid phone number.
Preferred Class

Group PianoIndividual (limited)
Level of Experience

BeginnerIntermediateAdvanced
Preferred day
Preferred Time
Medical Conditions or Allergies
Preferred payment
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Terms and Conditions:

By submitting this form, I acknowledge that participation in piano lessons involves an one semeter commitment and practice at home. I hereby release Hannah's Studio and its instructors from any liability for injuries or accidents that may occur during classes or events.
Signature

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Date signed

MonthDayYear
Date
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Piano Lessons Registration Form