Rouse Band Private Lesson Enrollment

General Information
Name of Primary Parent

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home/Cell Phone

Area CodePhone Number
Work Phone

Area CodePhone Number
Parent Email
Student Name

First NameLast Name
Student Grade in School
Student Instrument
Lesson Teacher Preference
Lesson Teacher (if selected "Other" from above)
Your preference for a lesson time is:
Financial Aid Information

Must qualify for Free or Reduced Lunch to be considered for Financial Aid through the District.
Would you like to apply for financial aid?
Final Step
My child has permission to participate in the Leander ISD Private Lesson Program. I have read the information regarding this program, and I agree to all conditions for participation. I will not hold the Leander ISD or any of its staff liable in the event of default by a private instructor.
Electronic Signature of Primary Parent or Guardian
Date of Submission

MonthDayYear
Should be Empty:

General Information