2013 Piano Lesson Registration Form

Name of parent/guardian:

Relation to student:

Contact number:

Student name:

Student age:

Prior study of piano? YES / NO

Prior study of other instruments? YES / NO

If yes, what and where?

Lesson Payment

Cash and Check ONLY

Circle choice below.

15 Minute Lessons: $7.00/ lesson 30 Minute Lessons: $15.00/ lesson

45 Minute Lessons: $22.00/ lesson 1 Hour Lessons: $30.00/ lesson

To access information about lessons from home, I opened a blog page where I post extra

information, practice sheets, pictures, and videos.

clarencepiano.blogspot.com