2017-2018 Piano Registration
Parents Name *
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Student Name(s) *
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Age of student(s) *
Your answer
Birthday(s) *
Your answer
School District *
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Grade(s) *
Your answer
Mailing Address *
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Phone Number(s) *
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E-mail(s) *
Your answer
Preferred lesson time length *
Private lessons will be scheduled during the afternoon and evening hours: Monday - Friday. Please list your 1st, 2nd, and 3rd choices for lesson times below (example: Monday after 4:00). Home school students may indicate a day time and Herndon Middle and High School students may indicate an early time of 3:15 or 3:30.Registration Fee of $75 (per student) is due July 1st. *
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I have read and agree to the 2017-2018 increase. *
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