Thank you for your interest in lessons with Lacey!

Please read through the Studio Policy and Tuition FAQ before filling out this form
Sign in to Google to save your progress. Learn more
Prospective Student's Name *
Student's Pronouns *
Required
Student's Birthday *
Minimum age is 5 years old for in-person lessons, and 8 years old for virtual lessons. If your child is under 8 and you feel that they are focused enough to succeed in virtual lessons, we may make an exception.
MM
/
DD
/
YYYY
Student's Grade, if applicable
Caregiver/Parent Name(s), if applicable
Primary Contact Email *
Primary Contact Phone # *
Secondary Contact E-mail, if applicable
Secondary Contact Phone #, if applicable
Caregivers, would you like for me to send lesson notes, newsletters, and relevant e-mails to your child as well? If so, please type their e-mail address below.
Home Address (for book delivery purposes) *
Please mark the tuition plan you are interested in. *
Required
What lesson option do you prefer? *
Do you currently have an instrument at home? If so, what kind? Please be specific. *
Briefly state your goals for lessons. *
Please list any known physical, developmental, behavioral, or sensory differences, or anything that you feel would help your child have a more successful learning experience and environment. Feel free to expand as much as you'd like. The more we know, the better we can understand and accommodate!
Cicada Music School might use photos or video of performances and lessons in promotional material and on social media. I give you permission to use: *
How did you hear about us? *
Any other comments or questions?
Please type your name to show that you have read and agree to the Studio Policy and Tuition FAQ. *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms