Private Lesson Registration // Weronika Balewski Music Studio
To reserve your weekly lesson time, you must a) pay full tuition or the first installment of tuition, and b) fill out this form. If you are a returning student and I already have your address and additional contact info, please feel free to skip that.
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Student Name *
Parent/Guardian Name (If student is under 18)
Email *
Phone Number *
Instrument *
Lesson Length *
Lesson Format *
Is the student fully vaccinated against Covid-19? *
Notes about vaccination (optional)
Age & Grade (or just write "adult") *
Student's School (If student is under 18) *
Main Address (Street, City, Zip)
Second Address (if applicable)
Additional Parent/Guardian/Caregiver Contact Info
Student Email & Phone Number (If student is under 18)
Student Contact Permission (If student is under 18)
Clear selection
Studio Policy Agreement *
Anything else you'd like to tell me?
Thank you!
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