Student Name *

First Name

Last Name

Parent Contact One *

First Name

Last Name

Parent Contact Two

First Name

Last Name

Physical Address *

If student has two addresses please just list the address for the adult responsible for billing

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Student Phone Number

(###)

###

####

Primary Parent Phone Number *

(###)

###

####

Secondary Number (or 2nd Parent Number)

(###)

###

####

Please select the instrument(s) you are registering for *

piano

guitar

voice

cello beginner

viola beginner

Please select the term you are registering for *

Spring 2025

Summer 2025

Fall 2025

What are your preferred days to meet? *

Monday

Tuesday

Wednesday

Thursday

Saturday

How often would you like to meet for lessons? *

twice weekly

once weekly

twice monthly

once monthly

Please enter Today's Date *

MM

DD

YYYY

Please confirm your submission *

Please type our full name to confirm you agree to and understand everything in your registration agreement: 1. Payment is due prior to or at the start of lessons, and if not received on time your lesson may be cancelled. 2. Missed lessons will either be made up or skipped depending on frequency of cancellation and instructor's availability 4. Frequent cancellations may result in the loss of your reserved day and time

First Name

Last Name