Registration Form

Student Information
Parent Name *
Parent Name
Student Name
Student Name
Phone *
Phone
Address
Address
Lesson Information
Lesson Length *
Please pick the length of lesson you would like per week.
Please indicate which instrument you will be studying.
Please let us know if you intend on studying a second instrument and/or additional students in your household will be taking lessons.
Please give us the best day and time for lessons. We'll schedule the lesson on the same day and time that you had the trial lesson with the teacher.
Preferred date of first lesson
Preferred date of first lesson
Did someone refer you? If so, please let us know! We will give you and the student you referred a free lesson as a way of saying thank you!
Please see rates on page https://www.pianoteachergirl.com/lessons/
Please check below to indicate that you have read and agree *
Please check below to indicate that you have read and agree *
Please check below to indicate that you have read and agree *
Please check below to indicate that you have read and agree *
Please check below to indicate that you have read and agree *
Please check below to indicate that you have read and agree *