2026 Piano Lessons In-Take Form
Please read the following prior to signing up: Cancellation Policy: We require minimum 24 hours notice for lesson cancellations. Lessons cancelled without sufficient notice may be charged at the regular rate. Music Preferences: Feel free to think about songs or styles you’d be interested in learning. Lesson Materials: For your introductory lesson, please bring a binder or folder to organize lesson materials. Bring this folder to future lessons as well.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Student's Name
*
First Name
Last Name
Student's Age (If under 18)
What piano service are you interested in?
*
30 Minutes
45 Minutes
1-Hour
90 Minutes
Are you open to online learning?
*
Yes
No
Unsure
Check if you know how to do any of the following:
*
Know the notes and where they are on the piano (A, B, C, D...)
Know how to read notes
Know how to play any chords
Know how to play any song at all (eg. Mary Had a Little Lamb)
Know how to play another instrument
None of the above
How often would you like lessons?
*
Weekly
Twice per week
Every other week
Casual
Check the days of the week you are available:
*
Monday
Tuesday
Wednesday
Thursday
None of the above
Check the times you are available:
*
9am-1pm (discounted rate)
1pm-3pm (discounted rate)
3pm-6pm
6pm-9pm
How did you hear about us?
*
Social Media
Google
Referral
Other
When would you like to begin lessons?
*
What do you hope to accomplish from these lessons?
*
Who are your favorite artists? Favorite songs?
*
Do you have any questions or comments?
Submit
Should be Empty: