This form is to register for lessons under the studio policies for the 2016 school year in my home studio. If you have not yet read these policies, take the time to do so now. Completion of this form indicates you thoroughly understand and agree to these policies. Any questions, please let me know.


Student's name *
Student's name
Student's date of birth
Student's date of birth
(if under age 18)
Parent's name
Parent's name
(if student is under age 18)
Student's address *
Student's address
Student's phone number *
Student's phone number
Unless arranged otherwise, lessons are assumed to be weekly and offered in 15-minute increments.
Select the day of the week agreed-to for your regular lesson time.
Scheduled lesson time *
Scheduled lesson time
Enter the time of your regularly scheduled lesson.
Do you consent to allow photos of the registering student to be published on this website? *
Refusal does not preclude the student from taking lessons.
Your typed name in this field indicate that you have thoroughly read, understood, and agreed to follow the current policies established by this studio, including the new payment schedule.