Piano Class Registration

Class Schedule:
7-9 year olds: Tuesdays 6:30-7:30
10-12 year olds: Thursdays 7:30-8:30

Fall 2018 Session:
September 4 - December 20

Complete This Form to Register for
Beginners' Group Piano Class

* Indicates required field

Student's Name *

First

Last

Age *

Grade in School *

Parent's Name(s) *

First

Last

Email *

Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Does this student have any learning or behavioral difficulties that the instructor might want to be aware of? If so, please describe. *

Does this student have any allergies or medical conditions that we should be aware of? *

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