Summer piano session registration

Piano summer sessions

registration form
Student Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Gender*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent E-mail*
Parent/guardian Mobile Number*

Area CodePhone Number
Childs shirt size*

Youth SAdult SYouth MYouth L
Available days/times

Please pick ONE day and time that works best for you. this will be your Childs reserved spot once a week to receive their piano lesson
what day are you interested in?*

MondayTuesdayWednesdaythursdayfriday
what time slot are you interested in?*

11:00 a.m - 12:00 p.m12:30 - 1:30 p.m2:00 - 3:00 p.m3:30 - 4:30 p.m5:00 - 6:00 p.m
payment option:*

two payments of $200 (due on 1st and 4th lesson)one discounted payment of $350 (one session free)
I understand that a payment according to my selection is due on the day of my child's first lesson. (cash check or PayPal)*

I agree
is a piano needed?*

yesno
Should be Empty:

Piano summer sessions