Enrollment Form

If you're interested in enrolling in private lessons, please fill out the form below.
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Student Name *
Date of Birth *
MM
/
DD
/
YYYY
Parent/Guardian Name (if Student is under 18)
Relation to Student
Address *
Phone *
Email *
What topic(s) would you like to learn?
Lesson Length
Clear selection
Lesson Day(s) Preference
Lesson Time Preference
Location *
* If the distance from my location (Madison, AL 35758) is more than 10 miles, additional travel expenses of $1.50 per mile may be charged for each extra mile, both to and from the destination.
In-Person Location (if applicable)
Additional Information
Submit
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