Registration
Six-Lesson Package
Parent/Adult Student Name
*
First Name
Last Name
Student Name (if under 18)
First Name
Last Name
Phone Number
*
Format: (000) 000-0000.
Parent/Adult Student Email:
*
example@example.com
Which best describes the student?
*
child/pre-college, has never taken piano lessons
child/pre-college, has studied piano
adult, has never taken piano lessons
adult, has studied piano
Please describe the student's prior experience with music or piano, if any.
Do you have a piano or keyboard at home?
*
yes, an acoustic piano (not electronic)
yes, a full-size digital piano (88 keys)
yes, a small keyboard (fewer than 88 keys)
no piano or keyboard
Preferred lesson location:
*
Kingston, NJ
Hopewell, NJ
No preference
Please indicate your preferred lesson times for Monday through Sunday.
*
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Payment
*
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Six 45-minute Private Lessons
$420.00
$
420.00
Book Fee
$30.00
$
30.00
Debit or Credit Card
Credit Card Number
Security Code
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