Sign Up for Piano Lessons with Aura Ruddell (2021-2022)

Thank you for your interest in piano lessons! Please read through my Studio Policy before filling out this form, as you will be asked to sign your consent to my policies at the end of this form.
Student's Name *
Student's Pronouns *
Student's Birthday *
Minimum age is 8 years, for virtual lessons. If your child is under 8 and you feel that they are focused enough to succeed in virtual lessons, please continue filling out this form.
Student's Grade, if applicable
Parent/Guardian Name(s), if applicable
Primary Contact E-mail *
Primary Contact Phone # *
Home Address (for book delivery purposes) *
Secondary Contact E-mail, if applicable
Secondary Contact Phone #, if applicable
Please mark the tuition plan you are interested in. *
Parents, would you like for me to send lesson notes, newsletters, and relevant e-mails to your children as well? If so, please type their e-mail addresses below.
Please list any known physical, developmental, behavioral, or sensory differences. Feel free to expand on any, if you're comfortable. The more I know, the better I can teach and accommodate!
Please indicate all days/times that you would be available for lessons. I cannot guarantee that your selections will be available by the time I receive your form, so please choose 2 or more options. All lesson times are in Pacific Standard Time. *
Briefly state your goals for piano lessons. *
Do you currently have a piano or keyboard at home? What kind? *
Cicada Music School may use photos or video of performances and lessons in promotional material and on social media. I give you permission to use: *
Is there anything else you would like for me to know? Do you have any questions?
Please sign your name to agree to the terms and conditions of Cicada Music School's 2021-2022 Studio Policy. *
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