Student Registration

To register for lessons complete our intake form below. Please note a yearly registration fee of $30 is required upon completion of this form.

Name

First Name

Last Name

Student Age

Student School

Parent/Guardian Name #1

Parent/Guardian Name #2

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Preferred Method of Contact

Phone

(###)

###

####

Does your child have prior piano experience? Yes/No? If, yes, how long, when, where?

Do you have a piano at home? Yes/No?

How did you hear about us?