2026 Piano Lessons In-Take Form

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 NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Student's Name*

First NameLast Name
Student's Age (If under 18)
What piano service are you interested in?*

30 Minutes45 Minutes1-Hour90 Minutes
Are you open to online learning?*

YesNoUnsure
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 notesKnow how to play any chordsKnow how to play any song at all (eg. Mary Had a Little Lamb)Know how to play another instrumentNone of the above
How often would you like lessons?*

WeeklyTwice per weekEvery other weekCasual
Check the days of the week you are available:*

MondayTuesdayWednesdayThursdayNone of the above
Check the times you are available:*

9am-1pm (discounted rate)1pm-3pm (discounted rate)3pm-6pm6pm-9pm
How did you hear about us?*

Social MediaGoogleReferralOther
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?
Should be Empty: