Enrollment Application
If you are interested in taking piano lessons please take a few moments to complete and submit our enrollment application. If a requested time-slot is available you will be contacted via the information provided in this form. An opening in the schedule will not always be available, however, and if this is the case you will be added to our waiting list to be contacted should a time become available.
Student Name
(First, Middle, Last)*

Student Age*

Parent Name* Desired Lesson Time*
Home Address City
Zip Code  
Home Phone* Work Phone
Cell Phone*  
Emergency Contact Emergency Phone
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E-mail Address*
Comments  
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