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student registration form

Name (please register each student separately) *

First

Last

Registration is for: *

Summer Term, 2017 - May 30 to August 10. No lessons from 6/26 to 7/7. Fall Term, 2017

Choose One *

Continuing student Transfer Student New Student

Best Phone Number *

What type of phone line is it? *

Alternate Phone Number *

What type of phone line is it? *

Email address *

Parent name(s) if applicable *

Address (leave blank if continuing student) *

Line 1

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City

State

Zip Code

Country

Taking private piano lessons over the summer? *

Yes No

Lesson Length (for individual piano lessons) *

Group classes - weekly classes through the summer term. Choose one or leave blank if not taking group classes. Class times will be determined by students' availability. - $135 *

Activities and Games - Tuesdays 4:45-5:45 - This class is designed to help students become familiar with music theory, repertoire, and performance practices through games and activities - for elementary ages and piano levels. Radio Music - Wednesdays 5-6pm - Weekly class designed to help students to play and write popular songs. Jazz and Improvisation - Thursdays 5:30-6:30pm - Weekly class where students learn to play together in a group, to improvise and elements of music theory focused in jazz.

Please list any dates you will be unavailable between May 30th and the end of 2017. Tuition is prorated based on availability. *

Please list all times you are available for piano lessons, Tuesdays through Thursdays, 11am-7pm. You may enter preferred times as well. *

How did you hear about Adam Revell? *

Comments or questions *

By registering for piano lessons on a weekly basis, I understand that being present at every scheduled lesson is a requirement. I understand that I am paying for a weekly time slot, and that slot is exclusively mine unless we agree on changing to a different time. I understand that there are no refunds for missed lessons, but that instead, makeup lessons will be scheduled up to once per month. Lessons cancelled less than 24 hours in advance due to sickness or family emergency will be rescheduled to a makeup day. Lessons canceled less than 24 hours in advance for other reasons will not be refunded or rescheduled.

By filling out and submitting this form, I understand that I am registering for piano lessons, and I have read and understand the piano lessons policies, found on the "Piano Lessons" page. *

I agree, and wish to register I am contacting you about something else (please indicate in the "comments or questions'" field)