Registration Form

Home | Registration S Form

Registration S Form

* Indicates required field

Student Name *

Date of Birth *

Parent's Names (If Applicable) *

Phone *

Email *

Address *

City *

State *

Zip *

Lessons on which Instrument? *

Name On Debit/Credit Card *

Debit/Credit Card Number *

Expiration Date *

CVC Number *

Years of experience with music or Instrument *

Lesson Day *

Lesson Time *

Lesson Length *

Where did you hear about us? *

Goals *

Comments or Questions *

Lesson Policy *

: We require a 24 hour notice to be able to reschedule a lesson. If a student has to miss a lesson in less than the 24 hour notice period, the teachers will do their best to set up a lesson on another day to make it up, if that's not possible, they can add time to their lessons for the next few weeks. (i.e. 15 minutes extra time for 3 weeks for a regular 45 minute lesson). Complete cancelation of all future lessons requires 2 weeks notice.

Submit

We've Been Voted "Best Piano Lessons in Burbank"
for the past 3 years.