Name
*
Email Address
*
Phone Number
*
Address
*
City, State, Zip Code
*
Student's Name
*
Student's Age
*
Instrument
Years Played
"none" if no expirience
Day Preference
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Time Preference
Morning
Afternoon
Evening
Policies
*
-A 30 day notification must be given for cancellations.
-A 24 hour notice is required for missed lessons. A make-up lesson will be rescheduled.
-Payment is accepted by a Credit or Debit card only. Charges will be made on the 1st of each month for the amount of your lessons for that month.
-Individual In-home lessons are $35/lesson (30 minute lesson).
-There is a one-time $35 Registration Fee (includes Initial lesson books, Recitals, and administration costs.)
-Please initial above to show that you understand these policies.
Credit Or Debit Card Type
*
Visa
Mastercard
American Express
Discover
Credit or Debit Card Number
*
Expiration Date
*
CCV
*
This is the 3 or 4 number security code that is located on the back of the card (on the front for AMEX cards)