Registration Form

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:

  1. Full Term Payments: Fall Term- $450, Spring Term- $450, Summer Term- $180
  2. Monthly Payments: 12 monthly payments of $90 each

Circle which payment plan you prefer:

Monthly Payments                 Full Term Payments