2022 Summer Registration Form
Palmer Piano Studio
Parent #1
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent #2
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Who should I contact first when needed?
*
Parent #1
Parent #2
Contact Student(s) Directly
Our family will...
*
Pay in full by June 15, 2022
Pay 1/2 by June 15, 2022 and balance by July 15, 2022
Pay weekly, at or prior to each lesson
Student #1
Name
*
First Name
Last Name
Phone Number
Please enter a valid phone number if you wish for me to communicate with your student directly.
Lesson Length
*
30 minutes, minimum of 6 throughout summer 2022 ($25/lesson)
45 minutes, minimum of 4 throughout summer 2022 ($37.50/lesson)
Does this student intend to take more lessons than the minimum this summer?
*
Yes
No
Maybe
What Piano Adventure(s) is this student choosing? Please check all that interest this student.
*
Custom Piano Lessons
Ensembles
Piano Music From Around the World
Composition
Theory
Music Bridges
Your Choice
If you selected "Your Choice" above, please explain here:
Student #2 (If Applicable)
Name
First Name
Last Name
Phone Number
Please enter a valid phone number if you wish for me to communicate with your student directly.
Lesson Length
30 minutes, minimum of 6 throughout summer 2022 ($25/lesson)
45 minutes, minimum of 4 throughout summer 2022 ($37.50/lesson)
Does this student intend to take more lessons than the minimum this summer?
Yes
No
Maybe
What Piano Adventure(s) is this student choosing? Please check all that interest this student.
Custom Piano Lessons
Ensembles
Piano Music From Around the World
Composition
Theory
Music Bridges
Your Choice
If you selected "Your Choice" above, please explain here:
Submit
Should be Empty: