Piano Lesson Registration

Parent Full Name

Student Full Name

Student Age

Student School


Student Level
BeginnerIntermediateAdvanced

Formal Training
None1-2 Years2-4 Years

Instrument Owned
NoneDigital KeyboardPiano

Goals
FunRecitalsRead Music



Lesson Time Preferences

Monday
1 PM2 PM3 PM4 PM5 PM6 PM7 PM8 PM


Tuesday
1 PM2 PM3 PM4 PM5 PM6 PM7 PM8 PM


Wednesday
1 PM2 PM3 PM4 PM5 PM6 PM7 PM8 PM


Thursday
1 PM2 PM3 PM4 PM5 PM6 PM7 PM8 PM


Friday
1 PM2 PM3 PM4 PM5 PM6 PM7 PM8 PM


Saturday
1 PM2 PM3 PM4 PM5 PM6 PM7 PM8 PM

*Please note that you will be placed on a waiting list if your desired times are unavailable.


Email (required)

Phone Number (required)

Address (required)

City



Anything else the teacher should know?