Studio Year: August 2020 – July 2021
Name of Parent/Guardian: ______________________________
Relation to Student: ___________________________________
Contact Number: _____________________________________
Contact Email: _______________________________________
Student Name: ______________________________________
Student Age: _____________
Prior Piano Lessons: Yes / No
If yes, for how long? ___________________________________
What are your specific goals for learning the piano?
I teach from 3:30pm-5:30pm on the following days: Tuesday, Thursday, and Friday.
Circle which day/s work best for you:
Tuesday Thursday Friday
Do you have a preference for time of day for your lesson? ______________________
* I cannot guarantee an opening for your preferred piano lesson slot, but would still love
to do what works best for you. I will get back to you on availability.
Tuition and Billing
Tuition is billed per studio year (40 weeks) with two different payment options:
- Full Term Payments: Fall Term- $450, Spring Term- $450, Summer Term- $180
- Monthly Payments: 12 monthly payments of $90 each
Circle which payment plan you prefer:
Monthly Payments Full Term Payments